The treatment for conjunctivitis depends on the underlying cause, which can be infectious (bacterial or viral) or allergic.
Infectious conjunctivitis
- Bacterial conjunctivitis: Most cases are self-limiting and resolve without treatment. However, topical antibiotics can decrease the duration of symptoms and allow earlier return to school or work . The AAO 2019 guidelines recommend offering topical antibiotic eye drops as the preferred treatment choice in patients with bacterial keratitis . In cases of gonococcal conjunctivitis, the CDC 2021 guidelines recommend administering single-dose ceftriaxone 1 g IM . For conjunctivitis secondary to sexually transmitted diseases such as chlamydia, systemic treatment in addition to topical antibiotic therapy is required
- Viral conjunctivitis: This is the most common cause of infectious conjunctivitis and usually does not require treatment. The management is supportive
Allergic conjunctivitis
- Topical antihistamines and mast cell stabilizers: These are recommended for alleviating symptoms of allergic conjunctivitis . The GESOC/SEAIC 2015 guidelines suggest preferring topical antihistamines over oral drugs due to their faster onset of action when symptoms are mainly ocular
- Topical NSAIDs: The GESOC/SEAIC 2015 guidelines suggest ophthalmic NSAIDs (diclofenac, flurbiprofen, and ketorolac) for conjunctival hyperemia and pruritus
- Topical corticosteroids: The GESOC/SEAIC 2015 guidelines recommend offering less potent corticosteroids (such as fluorometholone, medrysone, loteprednol, or rimexolone) for the treatment of moderate inflammation. Betamethasone, dexamethasone, or prednisolone can be offered in patients with severe inflammation
- Topical cyclosporine and tacrolimus: The JSA/JSOA 2022 guidelines suggest offering combination therapy with cyclosporine and corticosteroid eye drops for vernal keratoconjunctivitis and atopic keratoconjunctivitis in patients with conjunctival proliferative changes . Tacrolimus can also be considered in combination with corticosteroid eye drops for severe conjunctival proliferative changes
- Systemic immunosuppressants: In rare circumstances, systemic immunosuppressants such as montelukast, aspirin, interferons, cyclosporine, or tacrolimus may be considered
Nonpharmacologic interventions
- Eye hygiene: The GESOC/SEAIC 2015 guidelines recommend advising the application of cold compresses soaked in water, preservative-free artificial tears, and saline solution, and washing allergens from the conjunctiva to relieve edema and hyperemia
In conclusion, the treatment of conjunctivitis is multifaceted and depends on the underlying cause. It may involve the use of topical or systemic medications, as well as nonpharmacologic interventions.