What is the best treatment for acute conjunctivitis?

From the Guidelines

The most effective treatment for acute conjunctivitis is directed at the root cause, with antibiotic eye drops such as fluoroquinolones being a preferred choice for bacterial conjunctivitis, as they reduce the duration of symptoms 1. For bacterial conjunctivitis, antibiotic eye drops like moxifloxacin are effective, typically used 1-2 drops 4 times daily for 5-7 days.

• The treatment approach should prioritize the cause of conjunctivitis, with viral conjunctivitis typically resolving on its own within 1-2 weeks and requiring only supportive care with artificial tears and cold compresses 1.
• Allergic conjunctivitis responds well to antihistamine eye drops like ketotifen 0.025% (twice daily) or olopatadine 0.1% (once or twice daily). It's crucial to practice good hygiene by washing hands frequently, avoiding touching the eyes, and using separate towels and pillowcases to prevent spread. If symptoms worsen, vision becomes affected, or there's severe pain, medical attention should be sought immediately as these could indicate a more serious condition requiring different treatment 1. The use of topical antibiotics should be considered not only for infections with moderate or severe presentations but also for mild cases, as they reduce the duration of symptoms 1.

From the FDA Drug Label

Moxifloxacin ophthalmic solution, 0. 5% is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms:

The most frequently reported ocular adverse events were conjunctivitis, decreased visual acuity, dry eye, keratitis, ocular discomfort, ocular hyperemia, ocular pain, ocular pruritus, subconjunctival hemorrhage, and tearing.

In two randomized, double-masked, multicenter, controlled clinical trials in which patients were dosed 3 times a day for 4 days, moxifloxacin ophthalmic solution produced clinical cures on Day 5 to 6 in 66% to 69% of patients treated for bacterial conjunctivitis.

Moxifloxacin is a potential treatment option for bacterial conjunctivitis.

• The clinical cure rate for moxifloxacin in treating bacterial conjunctivitis is between 66% to 69%.
• Moxifloxacin has been shown to be effective against various strains of bacteria that cause conjunctivitis, including Staphylococcus aureus and Streptococcus pneumoniae.
• However, it is essential to note that the best medication for acute conjunctivitis may vary depending on the specific cause and severity of the infection, as well as the patient's individual needs and medical history.
• The decision to use moxifloxacin or any other medication should be made under the guidance of a healthcare professional 2, 2, 2.

From the Research

Types of Conjunctivitis

• Viral conjunctivitis: usually does not require treatment, with signs and symptoms at presentation being variable 3
• Bacterial conjunctivitis: most uncomplicated cases resolve in 1 to 2 weeks, with topical antibiotics decreasing the duration of the infection and allowing earlier return to school or work 3
• Allergic conjunctivitis: encountered in up to 40% of the population, with itching being the most consistent sign, and treatment consisting of topical antihistamines and mast cell inhibitors 3

Treatment of Acute Conjunctivitis

• Infective conjunctivitis should be managed conservatively, with antibiotics prescribed either after a delayed period if symptoms do not improve within 3 days of onset, or not at all 4
• Topical antibiotics are associated with a modestly improved chance of resolution in comparison to the use of placebo, with no evidence of serious side effects reported 5
• Treatment with antihistamines and mast cell stabilizers alleviates the symptoms of allergic conjunctivitis 3
• Conjunctivitis caused by gonorrhea or chlamydia and conjunctivitis in contact lens wearers should be treated with antibiotics 3

Diagnosis and Management

• The diagnosis of acute infectious conjunctivitis can be difficult, with clinical ambiguity existing between the acute viral and bacterial as well as the allergic forms 6
• Physicians must be aware of the clinical signs and symptoms and available diagnostic tests that can provide a more accurate differential diagnosis 6
• Distinguishing between acute viral and bacterial conjunctivitis remains difficult, with patients with prolonged symptoms, poor response to initial management, or evidence of severe disease requiring referral to ophthalmology for consultation 7