From the Guidelines
The current recommendations for treating pink eye (conjunctivitis) prioritize symptom relief and avoiding unnecessary antibiotic use, with treatment directed at the root cause of the condition, as outlined in the most recent guidelines from 2024 1. The approach to treating conjunctivitis depends on whether the cause is viral, bacterial, or allergic.
- For viral conjunctivitis, which is the most common form, treatment focuses on symptom relief with artificial tears, cold compresses, and allowing the infection to resolve on its own within 1-2 weeks, without the need for antibiotics 1.
- For bacterial conjunctivitis, antibiotic eye drops such as erythromycin ointment, polymyxin B-trimethoprim drops, or fluoroquinolones like moxifloxacin are typically prescribed, used 3-4 times daily for 5-7 days, as they can reduce the duration of symptoms and the risk of transmission 1.
- Allergic conjunctivitis responds well to antihistamine eye drops like ketotifen (Zaditor) or olopatadine (Pataday), used twice daily, along with avoiding allergens and using cold compresses 1. It's crucial to avoid touching or rubbing the eyes, wash hands frequently, avoid sharing towels or pillowcases, and discard eye makeup that may be contaminated to prevent the spread of infection. Contact lens wearers should temporarily switch to glasses until symptoms resolve. If symptoms worsen, vision becomes affected, or there's severe pain or sensitivity to light, seeking immediate medical attention is advised as these could indicate a more serious condition requiring different treatment 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.
Treating Pink Eye: The current recommendations for treating pink eye (bacterial conjunctivitis) include using moxifloxacin ophthalmic solution, 0.5%.
- Dosage: Instill one drop in the affected eye 3 times a day for 7 days.
- Efficacy: Moxifloxacin ophthalmic solution has been shown to produce clinical cures in 66% to 69% of patients treated for bacterial conjunctivitis.
- Safety: 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. 2 2 2
From the Research
Current Recommendations for Treating Pink Eye
The current recommendations for treating pink eye, also known as conjunctivitis, vary depending on the cause of the infection.
- For viral conjunctivitis, treatment is supportive, as it usually does not require treatment and resolves on its own 3.
- For bacterial conjunctivitis, topical antibiotics can decrease the duration of the infection and allow for an earlier return to school or work 3, 4.
- For allergic conjunctivitis, treatment consists of topical antihistamines and mast cell inhibitors, which can alleviate symptoms 3.
- For conjunctivitis caused by sexually transmitted diseases such as chlamydia and gonorrhea, systemic treatment in addition to topical antibiotic therapy is required 3, 5.
Antibiotic Susceptibility and Resistance
Studies have shown that bacteria causing conjunctivitis are highly sensitive to most commercially available antibiotics, but significant resistance has been found against certain antibiotics such as Bacitracin, Neomycin, and Polymyxin-B 6.
- Moxifloxacin has been found to be the most effective antibiotic for treating bacterial conjunctivitis 6.
- The use of antibiotic drops and ointments has been shown to be effective in reducing bacterial colonization on the lid margin, with no significant difference between the two forms of treatment 4.
Clinical Practice Guidelines
Clinical practice guidelines (CPGs) for infectious and non-infectious conjunctivitis have been systematically reviewed, and recommendations for treatment have been summarized 5.
- Non-pharmacological interventions such as artificial tears and cold compresses are recommended for non-infectious conjunctivitis.
- Pharmacological interventions such as topical anti-histamines and mast cell stabilizers are recommended for allergic conjunctivitis.
- Observation without treatment is recommended for non-herpetic viral and bacterial infections, while systemic and topical anti-viral treatment is recommended for herpetic viral conjunctivitis.