What is the treatment for conjunctivitis (pink eye)?

From the Guidelines

Pink eye, or conjunctivitis, should be treated based on its cause, with a focus on symptom relief for viral cases and antibiotic treatment for bacterial cases, as recommended by the most recent guidelines 1.

Treatment Approach

The treatment approach for pink eye depends on the underlying cause, which can be viral, bacterial, or allergic.

• For viral pink eye, which is the most common type, treatment focuses on symptom relief while the infection resolves on its own within 1-2 weeks.
• For bacterial pink eye, antibiotic eye drops such as Polymyxin B-trimethoprim (Polytrim) or erythromycin ointment are typically prescribed, used as directed for 5-7 days.
• For allergic pink eye, antihistamine eye drops like ketotifen (Zaditor, Alaway) can provide relief.

Symptom Relief and Prevention

To manage symptoms and prevent the spread of infection:

• Apply cold compresses to the affected eye for 5-10 minutes several times daily.
• Use artificial tears like Refresh or Systane as needed for comfort.
• Keep the eye clean by gently wiping from inner to outer corner with a clean, damp cloth.
• Avoid touching your eyes, wash hands frequently, don't share towels or pillowcases, and discard eye makeup used during infection.

When to Seek Medical Attention

Pink eye is highly contagious, so it's essential to stay home from work or school until discharge clears up, typically 24 hours after starting antibiotics for bacterial cases. If symptoms worsen, vision becomes affected, or the condition doesn't improve within a few days, seek medical attention immediately 1.

Evidence-Based Recommendations

The most recent guidelines recommend topical antibiotics for the treatment of conjunctivitis, including mild cases, as they reduce the duration of symptoms 1. However, the choice of antibiotic should be based on local availability and resistance patterns. Topical fluoroquinolones are recommended for bacterial keratitis, and intravitreal treatment with ceftazidime plus vancomycin and systemic treatment with ceftriaxone plus vancomycin are proposed for endophthalmitis 1.

From the FDA Drug Label

INDICATIONS AND USAGE: For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms. INDICATIONS AND USAGE For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin. The treatment for pink eye (superficial ocular infections involving the conjunctiva and/or cornea) includes:

• Bacitracin (OPHTH) 2
• Erythromycin (OPHTH) 3 Key points:
• These medications are used to treat superficial ocular infections caused by susceptible organisms.
• The specific medication and dosage should be determined by a healthcare professional based on the severity and cause of the infection.

From the Research

Treatment Options for Pink Eye

• Bacterial conjunctivitis, which is characterized by a purulent eye discharge, sticky eyes, foreign body sensation, and conjunctival injection (pink eye), can be treated with topical antibiotics, as they shorten the course of the disease, reduce discomfort, and prevent person-to-person transmission 4.
• For allergic conjunctivitis, treatment options include oral antihistamines, topical antihistamines, topical vasoconstrictors, mast cell stabilizers, NSAIDs, and topical corticosteroids 5.
• Topical antihistamines are often efficacious and provide faster and superior relief than systemic antihistamines, with some having anti-inflammatory properties as well 5.
• Mast cell stabilizers, such as sodium cromoglicate, may be considered, but they generally have a slower onset of action 5.
• Topical corticosteroids may be considered for severe seasonal ocular allergy symptoms, but long-term use should be avoided due to risks of ocular adverse effects 5.

Types of Allergic Conjunctivitis and Treatment

• Allergic conjunctivitis is an allergen-induced immune response, and treatment options include mast cell stabilizers, antihistamines, dual-acting agents, steroids, NSAIDs, and other off-label treatment modalities 6.
• The choice of treatment depends on the severity and type of allergic conjunctivitis, as well as the patient's individual needs and preferences 6.
• It is essential to note that the prevalence of allergic conjunctivitis is increasing, especially among children, and approximately 40% of North Americans and 20% of the world's population are impacted by some form of allergy 6.