What is the treatment for conjunctivitis in adults?

Treatment for Conjunctivitis in Adults

Treatment depends on the etiology: viral conjunctivitis requires only supportive care, bacterial conjunctivitis may benefit from topical antibiotics in moderate-to-severe cases, and allergic conjunctivitis responds to topical antihistamines with mast cell-stabilizing activity. 1

Initial Diagnostic Approach

Determine the etiology based on clinical presentation:

• Viral conjunctivitis presents with watery discharge, follicular reaction on inferior tarsal conjunctiva, preauricular lymphadenopathy, and often concurrent upper respiratory infection 1, 2
• Bacterial conjunctivitis shows mucopurulent discharge with matted eyelids upon waking, papillary (not follicular) reaction, and absence of itching 1, 3
• Allergic conjunctivitis features itching as the most consistent symptom, bilateral presentation, watery discharge, and absence of preauricular lymphadenopathy 1

Treatment by Etiology

Viral Conjunctivitis

Avoid antibiotics entirely—they provide no benefit and may cause toxicity. 1, 2

Supportive care includes:

• Artificial tears for symptomatic relief 1, 4
• Cold compresses 1
• Topical antihistamines for symptomatic relief 1

Patient education is critical:

• Emphasize high contagiousness and minimize contact with others for 10-14 days from symptom onset 1
• Strict hand hygiene with soap and water (not sanitizer alone) 2
• Use separate towels and avoid sharing personal items 1

For severe cases with marked chemosis and lid swelling:

• Consider short course of topical corticosteroids with close ophthalmology follow-up 1
• Monitor intraocular pressure regularly and perform periodic pupillary dilation 1, 2
• Caution: Corticosteroids may prolong viral shedding and worsen HSV infections 1

Bacterial Conjunctivitis

Mild cases are usually self-limited and may resolve without treatment, but topical antibiotics may decrease duration. 1, 2

For moderate-to-severe cases:

• Prescribe 5-7 day course of broad-spectrum topical antibiotic 1
• No evidence demonstrates superiority of any specific topical antibiotic agent 2, 1
• Moxifloxacin 0.5% ophthalmic solution: one drop in affected eye 3 times daily for 7 days 5

Special considerations:

• Gonococcal conjunctivitis requires systemic treatment in addition to topical therapy, with hospitalization for parenteral therapy, and can lead to corneal perforation 1, 2
• Chlamydial conjunctivitis requires systemic treatment and evaluation of sexual partners 1, 2
• MRSA is increasingly isolated, but fluoroquinolones remain effective 1

Allergic Conjunctivitis

First-line treatment: topical antihistamines with mast cell-stabilizing activity (e.g., olopatadine or ketotifen). 1

Environmental modifications:

• Wear sunglasses as barrier to airborne allergens 1
• Use cold compresses and refrigerated artificial tears 1
• Avoid eye rubbing 1

For refractory cases:

• Consider short-term corticosteroids (brief 1-2 week course with low side-effect profile) 1
• Allergen-specific immunotherapy is beneficial, more so in children than adults 2
• Multidisciplinary approach with allergists may be beneficial 2

Red Flags Requiring Immediate Ophthalmology Referral

Refer urgently if any of the following are present: 1

• Visual loss or decreased vision
• Moderate or severe pain
• Severe purulent discharge
• Corneal involvement
• Conjunctival scarring
• Lack of response to therapy
• Recurrent episodes
• History of HSV eye disease
• Immunocompromised state

Critical Pitfalls to Avoid

• Never use topical corticosteroids indiscriminately—they can prolong adenoviral infections, worsen HSV infections, and cause increased intraocular pressure and cataracts 1, 2
• Avoid contact lens wear during any form of infectious conjunctivitis 1
• Do not miss gonococcal conjunctivitis—it requires immediate systemic treatment to prevent corneal perforation 1
• Chronic/recalcitrant conjunctivitis may indicate underlying malignancy (sebaceous or squamous cell carcinoma) and requires further evaluation 1, 2

Follow-Up Recommendations

• Severe viral conjunctivitis: Re-evaluate within 1 week 1
• Patients not on corticosteroids: Return if symptoms persist beyond 2-3 weeks 1
• Patients on topical corticosteroids: Regular monitoring of intraocular pressure and periodic pupillary dilation 1, 2
• Frequency of follow-up visits depends on disease severity and treatment used 2