From the Guidelines
Conjunctivitis should be treated based on its cause, with a focus on avoiding indiscriminate use of topical antibiotics or corticosteroids, as they can induce toxicity or worsen certain infections, such as adenoviral or HSV infections 1. When treating conjunctivitis, it is essential to consider the underlying cause, as different types of conjunctivitis require distinct approaches.
- Bacterial conjunctivitis can be treated with antibiotic eye drops, such as polymyxin B-trimethoprim (Polytrim) or erythromycin ointment, applied 4 times daily for 5-7 days.
- Viral conjunctivitis, the most common type, typically resolves on its own within 1-2 weeks, and symptom relief can be achieved with artificial tears and cold compresses.
- Allergic conjunctivitis responds well to antihistamine eye drops, such as ketotifen (Zaditor) or olopatadine (Pataday), used twice daily. It is crucial to avoid touching the eyes, wash hands frequently, not share towels or pillowcases, and discard eye makeup to prevent spreading the infection. Patients with conjunctivitis should be evaluated by an ophthalmologist in certain circumstances, including visual loss, moderate or severe pain, or severe, purulent discharge 1. In general, patients with conjunctivitis who experience severe symptoms, such as visual loss, moderate or severe pain, or severe, purulent discharge, should be referred promptly to an ophthalmologist for further evaluation and treatment 1.
From the FDA Drug Label
For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms. For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin.
Conjunctivitis Treatment:
- Bacitracin (OPHTH) is indicated for the treatment of superficial ocular infections involving the conjunctiva caused by Bacitracin susceptible organisms 2.
- Erythromycin (OPHTH) is indicated for the treatment of superficial ocular infections involving the conjunctiva caused by organisms susceptible to erythromycin 3.
From the Research
Causes of Conjunctivitis
- Conjunctivitis can be caused by viruses, bacteria, or allergies 4, 5
- Viral conjunctivitis is the most common overall cause of infectious conjunctivitis and usually does not require treatment 4
- Bacterial conjunctivitis is the second most common cause of infectious conjunctivitis, with most uncomplicated cases resolving in 1 to 2 weeks 4
- Allergic conjunctivitis is encountered in up to 40% of the population, but only a small proportion of these individuals seek medical help 4
Symptoms of Conjunctivitis
- Itching is the most consistent sign in allergic conjunctivitis 4
- Mattering and adherence of the eyelids on waking, lack of itching, and absence of a history of conjunctivitis are the strongest factors associated with bacterial conjunctivitis 4
- Viral and allergic conjunctivitis are more common in adults and typically present with watery discharge 5
- Bacterial conjunctivitis is more common in children and typically presents as mucopurulent discharge with the eyelids matted shut 5
Treatment of Conjunctivitis
- Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work 4
- Treatment for viral conjunctivitis is supportive, including artificial tears, cold compresses, and antihistamine eye drops 5
- Topical antihistamines with mast cell-stabilizing activity are the treatment of choice for allergic conjunctivitis 5
- Artificial tears are the mainstay of dry eye disease management, but also have a role in conjunctivitis management 6
- Combination formulations of artificial tears are more effective than single active ingredient artificial tears 6
Management of Conjunctivitis
- Observation without treatment is strongly recommended for non-herpetic viral and bacterial infections 7
- Systemic and topical anti-viral is consistently recommended for herpetic viral conjunctivitis, while systemic and topical antibiotics are recommended for chlamydial and gonorrhoeal conjunctivitis 7
- Non-pharmacological interventions, such as artificial tears and cold compress, are recommended for non-infectious conjunctivitis 7
- Pharmacological interventions, such as topical anti-histamine and mast-cell stabiliser, are recommended for allergy types 7