Low-Cost Over-the-Counter Eye Drops for Pink Eye
For uncomplicated viral or allergic conjunctivitis, the most cost-effective OTC options are ketotifen (antihistamine/mast cell stabilizer) for allergic symptoms or preservative-free artificial tears for viral cases, both available generically at minimal cost. 1
Determining the Type of Conjunctivitis First
Before selecting drops, identify the likely etiology based on these key features:
- Viral conjunctivitis: Watery discharge, follicular reaction, often starts in one eye then spreads to the other, may have concurrent upper respiratory infection 2
- Allergic conjunctivitis: Bilateral itching (most distinguishing feature), watery discharge, seasonal pattern, no matted eyelids 1, 2
- Bacterial conjunctivitis: Mucopurulent discharge with matted eyelids on waking, lack of itching, more common in children 3, 4
Low-Cost OTC Options by Type
For Allergic Conjunctivitis (Most Amenable to OTC Treatment)
First-line low-cost option:
- Ketotifen 0.025% (generic Zaditor/Alaway): Dual-action antihistamine and mast cell stabilizer, available OTC, highly effective for both acute relief and prevention 1
- Dosing: Twice daily, can be stored in refrigerator for additional cooling relief 1
- Cost advantage: Generic versions are significantly less expensive than prescription alternatives
Adjunctive low-cost measures:
- Preservative-free artificial tears: Use 4 times daily to dilute allergens and inflammatory mediators 1
- Cold compresses: Provide immediate symptomatic relief at no cost 1, 5
- Store drops in refrigerator for enhanced cooling effect 1
For Viral Conjunctivitis (Supportive Care Only)
Recommended low-cost options:
- Preservative-free artificial tears: Apply frequently to lubricate and dilute inflammatory mediators 5
- Cold compresses: Reduce inflammation and provide symptomatic relief 5
- Oral analgesics: Acetaminophen or NSAIDs for pain management 5
Critical: Avoid antibiotics entirely - they provide no benefit for viral conjunctivitis and may cause unnecessary toxicity 2, 5
For Bacterial Conjunctivitis (Prescription Usually Needed)
Low-cost prescription options if treatment is pursued:
- Erythromycin ointment: Inexpensive, broad-spectrum, FDA-approved for superficial ocular infections 6, 4
- Bacitracin ointment: Another low-cost alternative 7
- Polymyxin B/trimethoprim drops: Cost-effective broad-spectrum option 2
Important consideration: Mild bacterial conjunctivitis is usually self-limited and resolves in 1-2 weeks without treatment 3, 4
Critical Pitfalls to Avoid
- Do NOT use OTC antihistamine/vasoconstrictor combinations (like naphazoline/pheniramine) chronically - they cause rebound hyperemia after 10 days 1
- Avoid oral antihistamines as primary treatment for allergic conjunctivitis - they worsen dry eye and are less effective than topical agents 1, 4
- Never use antibiotics for viral conjunctivitis - contributes to resistance and causes toxicity 2
When to Seek Medical Evaluation
Refer to ophthalmology or seek immediate care if any of these red flags are present 8, 2:
- Visual loss or decreased vision
- Moderate to severe pain
- Severe purulent discharge
- Corneal involvement
- Lack of response to therapy after 2-3 weeks
- History of herpes simplex virus eye disease
- Immunocompromised state
- Contact lens wearer with conjunctivitis (requires evaluation for corneal ulcer)
Practical Cost-Saving Algorithm
If itching is predominant symptom (allergic): Start generic ketotifen OTC twice daily + preservative-free artificial tears 4 times daily 1
If watery discharge without itching (likely viral): Use preservative-free artificial tears frequently + cold compresses, strict hand hygiene to prevent spread 5, 4
If mucopurulent discharge with matted lids (bacterial): Consider delayed antibiotic prescribing approach (wait 2-3 days to see if self-resolves) or obtain prescription for erythromycin ointment 6, 4
If no improvement in 48 hours on appropriate treatment or any red flags develop: Seek medical evaluation 1, 2