From the Guidelines
To treat conjunctivitis in toddlers, a 5- to 7-day course of a broad-spectrum topical antibiotic, such as Polymyxin B-trimethoprim or erythromycin ointment, is usually effective and can be selected based on convenience or cost, as there is no clinical evidence suggesting the superiority of any particular antibiotic 1.
Key Considerations
- The choice of antibiotic is usually empiric, and treatment may reduce transmissibility and allow for an earlier return to school for children 1.
- For mild bacterial conjunctivitis, topical antibacterial therapy is associated with earlier clinical and microbiological remission compared with placebo in days 2 to 5 of treatment 1.
- Povidone-iodine 1.25% ophthalmic solution may be as effective as topical antibiotic therapy for treating bacterial conjunctivitis and could be considered when access to antibiotics is limited 1.
Treatment Approach
- Determine the cause of conjunctivitis, as treatment varies for viral, bacterial, or allergic types.
- For viral conjunctivitis, focus on symptom relief with warm compresses applied to the eyes for 5-10 minutes several times daily to reduce discomfort and clean discharge.
- For bacterial conjunctivitis, use antibiotic eye drops such as Polymyxin B-trimethoprim or erythromycin ointment, usually administered 3-4 times daily for 5-7 days.
- For allergic conjunctivitis, remove the allergen if possible and consider pediatric-appropriate antihistamine eye drops like ketotifen (Zaditor) as directed by a pediatrician.
Prevention and Hygiene
- Gently clean the eye area with warm water and a clean cloth, wiping from inner to outer corner to prevent spreading infection.
- Keep your toddler from rubbing their eyes and maintain good hand hygiene.
- Separate their towels and washcloths from others to prevent transmission.
- Contact a doctor if symptoms worsen, if there's significant eye pain, vision changes, or if symptoms don't improve within 2-3 days.
- Most cases of conjunctivitis are highly contagious, so keep your child home from daycare until symptoms improve or as advised by your pediatrician, typically 24 hours after starting antibiotic treatment for bacterial cases 1.
From the Research
Treatment Options for Conjunctivitis in Toddlers
- The treatment of conjunctivitis in toddlers depends on the cause, which can be infectious (bacterial or viral) or non-infectious (allergic) 2, 3, 4.
- For bacterial conjunctivitis, topical antibiotics may be prescribed to shorten the duration of symptoms, although many cases are self-limiting and may resolve without treatment 5, 6.
- Viral conjunctivitis typically does not require treatment, and management is supportive, including the use of artificial tears and cold compresses 3, 4.
- Allergic conjunctivitis can be treated with topical antihistamines, mast cell stabilizers, or systemic antihistamines, and is often seasonal 2, 4.
Considerations for Treatment
- The use of antibiotics for acute bacterial conjunctivitis has been shown to improve clinical and microbiological remission rates compared to placebo, although the condition is often self-limiting 5, 6.
- Topical antibiotics may be considered to speed the resolution of symptoms and infection, especially in cases where there is a high risk of complications 6.
- It is essential to practice strict personal hygiene, including frequent handwashing, to decrease the risk of transmission of infectious conjunctivitis 3.