Conjunctivitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Medical Therapy

Pharmacotherapy

Acute Pharmacotherapies

Conjunctivitis sometimes requires medical attention. The appropriate treatment depends on the cause of the problem. For the allergic type, cool water constricts capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Some patients with persistent allergic conjunctivitis may also require topical steroid drops.

Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that cover a broad range of bacteria (chloramphenicol or fusidic acid used in UK). However evidence suggests that this does not affect symptom severity and gains only modest reduction in duration from an average of 4.8 days (untreated controls) to 3.3 days for those given immediate antibiotics. Deferring antibiotics yields almost the same duration as those immediately starting treatment with 3.9 days duration, but with half the two-week clinic reattendance rate.

Although there is no cure for viral conjunctivitis, symptomatic relief may be achieved with cool compresses and artificial tears. For the worst cases, topical corticosteroid drops may be prescribed to reduce the discomfort from inflammation. However prolonged usage of corticosteroid drops increases the risk of side effects. Antibiotic drops may also be used for treatment of complementary infections. Patients are often advised to avoid touching their eyes or sharing towels and washcloths. Viral conjunctivitis usually resolves within 3 weeks. However in worst cases it may take over a month.

Conjunctivitis due to burns, toxic and chemical require careful wash-out with saline, especially beneath the lids, and may require topical steroids. The more acute chemical injuries are medical emergencies, particularly alkali burns, which can lead to severe scarring, and intraocular damage. Fortunately, such injuries are uncommon.

Shown below tables of conjunctivitis medical therapy:

▸ Click on the following categories to expand treatment regimens.

Conjunctivitis Medical Therapy   ▸  Bacterial Conjunctivitis   ▸  Newborn Conjunctivitis   ▸  Viral Conjunctivitis

Bacterial Conjunctivitis Preferred Regimen Non-gonococcal ▸ Ciprofloxacin 1–2 gtts q2h while awake x 1st 2 days, then q4–8h x 7 days OR ▸ Gatifloxacin 1–2 gtts q2h while awake x 1st 2 days, then q4–8h x 7 days OR ▸ Levofloxacin 1–2 gtts q2h while awake x 1st 2 days, then q4–8h x 7 days OR ▸ Moxifloxacin 1–2 gtts q2h while awake x 1st 2 days, then q4–8h x 7 days Gonococcal Adult dose ▸ Ciprofloxacin 1 gm IM/IV as 1 dose Pediatric dose ▸ Ciprofloxacin 25-50 mg/kg IV/IM (not to exceed 125 mg) as 1 dose Alternative Regimen (for non-gonococcal only) ▸ Polymyxin B + Trimethoprim 1–2 gtts q3–6h x 7–10 days OR ▸ Azithromycin 1%, 1 gtt bid x 2 days, then 1 gtt daily x 5 days Chlamydia Trachomatis Preferred Regimen ▸ Azithromycin 1 gm once or twice weekly Alternative Regimen ▸ Doxycycline 100 mg bid po x 7 days Newborn Conjunctivitis Neisseria gonorrhoeae (after 2-5 days) ▸ Ceftriaxone 25-50 mg/kg IV x 1 dose (not to exceed 125 mg) Chlamydia trachomatis (after 3-10 days) ▸ Erythromycin base or ethyl succinate syrup 12.5 mg/kg q6h x 14 days OR ▸ Azithromycin suspension 20 mg/kg po q24h x 3 days Herpes simplex (after 2-16 days) † ▸ Acyclovir 60 mg/kg/day IV divided into 3 daily doses OR ▸ Trifluridine OR Vidarabine as a topical antiviral therapy † Systemic and CNS disease should be evaluated with PCR of CSF and serum and LFTs in any child with suspected HSV eye infection. Viral Conjunctivitis (pink eye) ▸ No treatment, but if symptomatic, use cold artificial tears

References

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