How Pink Eye (Conjunctivitis) Is Treated

Because the causes of pink eye (conjunctivitis) are so varied—triggered by everything from viral and bacterial infections to allergies and chemical exposure—the treatment must be tailored to the underlying cause. Mild conjunctivitis, while uncomfortable, may resolve on its own. Other cases may require antibiotics to treat a bacterial infection, topical steroids to reduce inflammation, and supportive therapies (such cold compresses and artificial tears) to help alleviate the pain and discomfort.

Home Remedies

Mild conjunctivitis will typically cause redness in one or both eyes as well as itchiness, burning, excessive tearing, and a gritty sensation whenever you blink. Whatever the underlying cause, mild cases may not require treatment and will often improve on their own within a couple of weeks.

While you wait, home remedies can be used to ease discomfort. They can also be used in tandem with medications prescribed for other forms of pink eye.

Self-Care Tips

The home treatment of conjunctivitis would be focused on alleviating discomfort, supporting healing, and preventing the further spread of infection.

Many people find relief with the use of either a cool or warm compress. If your pink eye is caused by an allergy, cool compresses can help relieve the itchiness and burning. If it has a viral or bacterial cause, a warm compress can reduce the redness and swelling. (To avoid the spread of infection from one eye to the next, use separate compresses for each eye and a fresh set of compresses for each treatment.)

Do not add herbal, aromatherapeutic, or other infusions to the compress, as this may inflame, rather than alleviate, the symptoms. Also, avoid any eye drops not approved for ophthalmic used by the Food and Drug Administration.

If you wear contact lenses, it is best to remove them until your symptoms are fully resolved. Once they are and you are no longer contagious, you should throw out any disposable contacts you've worn to prevent reinfection. Any non-disposable contacts should be disinfected overnight before reusing. (Just be doubly sure to check the expiration date of the disinfecting solution to ensure effective cleaning.)

Home Prevention

If the cause of the pink eye is infectious, such as with epidemic keratoconjunctivitis (EKC) outbreaks in daycare centers and schools, you and your family need to take precautions to avoid the further spread of infection (or re-infection). This includes:

  • Washing your hands regularly with hot water and soap
  • Avoiding touching the eyes
  • Not sharing towels, pillowcases, and handkerchiefs
  • Not sharing makeup or eye drops
  • Washing pillowcases and bedding regularly

Over-the-Counter (OTC) Therapies

Artificial tears, available over the counter, can provide relief by increasing eye lubrication and reducing some of the gritty sensations that can accompany pink eye.

There are many different variations, some of which contain lipids to mimic real tears (such as Refresh Optic Advance and Soothe from Bausch & Lomb) and others that are preservative-free to reduce the risk of allergy (such as TheraTears and Alcon Systane).

There are also formulations that have a thicker consistency (like Refresh Celluvisc or Systane Ultra), which may help reduce corneal abrasion by coating the eye longer. On the downside, they can also trap dust, pollen, and other allergens.

If an allergy is the underlying cause of your pink eye, an over-the-counter antihistamine like Claritin (loratadine), Zyrtec (cetirizine), or Allegra (fexofenadine) can help reduce itchiness. Antihistamine eye drops are also effective in providing fast relief.

Prescriptions

Certain forms of conjunctivitis may greatly benefit from prescription medication, while others require it.

Bacterial Conjunctivitis

Bacterial conjunctivitis generally lasts for one to two weeks and will usually resolve on its own. If the symptoms fail to improve after five days, your doctor may recommend antibiotic eye drops (typically a broad-spectrum antibiotic able to treat multiple bacterial types).

If the condition is severe, newer-generation fluoroquinolone eye drops may be prescribed. Oral antibiotics are generally reserved for severe infections, such as those caused by gonorrhea or chlamydia.

The most commonly prescribed antibiotic medications include:

  • Azithromycin 1.0% solution
  • Ciprofloxacin 0.3% drops or ointment
  • Erythromycin 0.5% ointment
  • Gentamicin 0.3% drops
  • Levofloxacin 0.5% drops
  • Ofloxacin 0.3% drops
  • Tobramycin 0.3% drops

While corticosteroid eye drops may be prescribed, their use remains controversial. While effective in alleviating inflammation, they can actually slow the healing process and may even "melt" the conjunctival membrane if overused.

Viral Conjunctivitis

Viral conjunctivitis is the type most familiar to parents with school-aged children. Epidemic keratoconjunctivitis (EKC) is caused by an adenovirus closely associated with the common cold. As there are no antiviral drugs able to cure EKC, the infection simply needs to run its course in the same way a cold would.

In the rare event that complications ensue, a topical antiviral such as cidofovir may be prescribed. Even then, these are generally reserved for people with compromised immune systems, such as those with advanced HIV infection.

The herpes simplex virus (HSV) is a less common cause of conjunctivitis but arguably a more problematic one, as it is more likely to recur. Treatment may involve a watch-and-wait approach if the condition is mild. Severe cases, in which corneal damage is possible, can be treated with either a topical antiviral (such as ganciclovir gel, trifluridine eye drops, or vidarabine ointment) or oral antiviral (such as acyclovir).

Allergic Conjunctivitis

Most cases of allergic conjunctivitis are treated conservatively with OTC antihistamines, nasal sprays, eye drops, and nonsteroidal anti-inflammatory drugs (NSAIDs).

If symptoms are persistent or recurrent, mast cell stabilizers, such as Alomide (lodoxamide) or Alocril (nedocromil), are available in prescription eye drops. In cases of atopic keratoconjunctivitis, in which the risk of vision loss is higher, the combined use of a topical mast cell stabilizer and an oral or topical corticosteroid is usually effective.

For cases of giant papillary conjunctivitis, in which chronic exposure to contact lenses and other foreign objects can cause pimple-like bumps on the inner eyelid, treatment typically involves the removal of the foreign object. Mast cell stabilizers or topical corticosteroids may be used in cases where the foreign object (such as sutures or an eye prosthetic) is less readily removed. Switching from hard lenses to soft lenses may also prevent recurrence.

Ophthalmia Neonatorum

Ophthalmia neonatorum, also known as neonatal conjunctivitis, is caused when a gonorrheal or chlamydial infection is transferred to the baby’s eyes as it passes through the birth canal.

To avoid this, mothers diagnosed at the time of birth may be offered a Cesarean section to reduce the risk of transmission. Irrespective of the mode of delivery, the baby will be given antibiotic eye drops at birth (either tetracycline or erythromycin) and a single dose of ceftriaxone if the mother has untreated gonorrhea.

If the baby develops symptoms of gonococcal conjunctivitis, an hourly saline eye wash would be performed until the discharge is cleared, supported by four hourly applications of bacitracin ointment. A seven-day course of systemic antibiotics would also be prescribed. Ceftriaxone, ciprofloxacin, and penicillin are effective options.

For chlamydial conjunctivitis, topical tetracycline or erythromycin ointment would be applied four times daily for three weeks, as well as systemic erythromycin to reduce the risk of pneumonia.

A less common form of neonatal conjunctivitis, caused by the herpes simplex virus, would be treated with acyclovir delivered intravenously for at least 14 days to prevent a widespread, systemic infection.

Emergency Care

Chemical conjunctivitis is caused by exposure to smoke, fumes, liquids, and other toxic agents. Mild forms, such as those caused by smoke or chlorine, usually resolve on their own within a day.

However, more severe exposures, such as those caused by an acid (like pool or battery acid) or an alkali (like ammonia or drain cleaner), should be thoroughly flushed with water while emergency care is sought. This is especially true with alkali burns which, even more than acid, can severe eye damage, often within seconds.

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