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 conjunctivitis, antibiotic eye drops for bacterial conjunctivitis, and antihistamine eye drops for allergic conjunctivitis, as indicated by the most recent guidelines 1.

Treatment Approach

The treatment of conjunctivitis is ideally directed at the root cause, with early detection and treatment being crucial for preventing complications, as noted in the conjunctivitis preferred practice pattern 1.

• For viral conjunctivitis, which is the most common type, treatment focuses on symptom relief since antibiotics are not effective.
• For bacterial pink eye, antibiotic eye drops like Polytrim (polymyxin B-trimethoprim) or Vigamox (moxifloxacin) are typically prescribed, used as directed for 5-7 days even if symptoms improve sooner.
• For allergic conjunctivitis, antihistamine eye drops such as Zaditor (ketotifen) or Pataday (olopatadine) can provide relief, with over-the-counter options including Alaway or Visine-A.

General Precautions

Regardless of the cause, it is essential to avoid touching or rubbing the eyes, wash hands frequently, use separate towels and washcloths, and discard eye makeup that may be contaminated, as emphasized in the guidelines 1.

• Most cases of pink eye resolve within 1-2 weeks.
• If symptoms worsen, vision becomes affected, or there is eye pain or sensitivity to light, it is crucial to seek medical attention promptly, as these could indicate a more serious condition 1.

Importance of Proper Diagnosis

It is vital to differentiate between primary conjunctival disease and conditions where conjunctival inflammation is secondary to systemic or ocular diseases, as the treatment should be directed at correcting the underlying problems, as highlighted in the conjunctivitis preferred practice pattern 1.

• Systemic conditions such as atopy or acute infections like gonorrhea may cause conjunctival inflammation, and treatment must include addressing the underlying systemic disease.

From the FDA Drug Label

Ofloxacin ophthalmic solution is indicated for the treatment of infections caused by susceptible strains of the following bacteria in the conditions listed below:

• CONJUNCTIVITIS: Gram-positive bacteria: Gram-negative bacteria: For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin.

Pink eye treatment options include:

• Ofloxacin (OPHTH) for conjunctivitis caused by susceptible bacteria 2
• Erythromycin (OPHTH) for superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin 3 The dosage of erythromycin ophthalmic ointment is approximately 1 cm in length applied directly to the infected eye(s) up to six times daily, depending on the severity of the infection 3

From the Research

Pink Eye Treatment Options

• The treatment of pink eye, also known as conjunctivitis, depends on the cause of the infection.
• For chlamydial conjunctivitis, effective anti-chlamydial agents include tetracyclines, macrolides, and some of the fluoroquinolones 4.
• Prolonged and frequent application of ophthalmic agents is vital for successful treatment of conjunctivitis 4.

Antibiotic Treatment for Bacterial Conjunctivitis

• Antibiotics are generally prescribed for acute bacterial conjunctivitis to speed recovery, reduce persistence, and prevent keratitis 5.
• Topical antibiotics have been shown to improve clinical cure rates by 26% compared to placebo 5.
• The use of topical antibiotics is associated with a modestly improved chance of resolution in comparison to the use of placebo 5.

Treatment of Allergic Conjunctivitis

• Ketotifen fumarate 0.025% ophthalmic solution has been shown to be effective in alleviating ocular symptoms of seasonal allergic conjunctivitis (SAC) after single-dose administration 6.
• Epinastine, ketotifen, and olopatadine have been found to be effective in the treatment of allergic conjunctivitis, with efficacy comparable to fluorometholone 7.
• Ketotifen 0.025% eye drops have been shown to be safe and statistically effective in preventing ocular itching, injection, and other signs and symptoms of allergic conjunctivitis 8.