THE TREATMENT OF PINK EYE

Conjunctivitis, commonly known as "pink eye" can be allergic, viral, or bacterial in nature. Pathogens most frequently responsible for bacterial conjunctivitis are Streptococcus pneumoniae, Haemophilus influenza, and Staphylococcus aureus.

One way to differentiate bacterial from viral conjunctivitis is that bacterial conjunctivitis usually presents with a purulent discharge. A watery discharge is commonly seen with viral conjunctivitis. Symptoms of bacterial conjunctivis include red eyes, swelling, eyelids sticking together, itching, watering, and a white or yellow sticky discharge from the eyes.

Bacterial conjunctivitis is frequently self-limiting, resolving spontaneously within seven to 14 days in 60% to 70% of the cases. However, treatment with antibacterial agents provide marginal benefit by leading to a faster clinical and microbiological cure and reducing the rate of disease transmission and the chance of rare complications. In addition, some daycares and schools require children with conjunctivitis to be treated with an ophthalmic antibacterial for at least 24 to 48 hours before they can return.

To help manage symptoms of bacterial conjunctivitis, recommend cold or warm compresses, lubricants, ocular decongestants, etc. Bacterial conjunctivitis can be considered contagious until antibiotics have been on board for 24 to 48 hours or until symptoms clear. I emphasize proper hygiene (e.g., hand washing, not touching the eyes with hands, use clean washcloths, etc) and avoiding close contact with others to prevent spreading the infection. I tell patients who use contact lenses to wear their prescription eyeglasses instead, until the infection is cleared.

The goals when treating bacterial conjunctivitis are to improve patient comfort, reduce the course of infection/inflammation, and prevent the spread of infection. Topical therapy is usually sufficient. Eyedrops have the advantage of not interfering with vision and are generally the preferred form for adults. On the other hand, ointments have the advantage of prolonged contact with the ocular surface and are usually preferable in young children. Improvement is generally seen within three to four days of treatment initiation. Patients should be referred to an ophthalmologist if there is no improvement within the first 24 hours after initiation of therapy or if the condition worsens.

Topical corticosteroids should be avoided since some conditions that present as a red eye with watery discharge, such as herpetic keratitis, can worsen with corticosteroid use.

Treatment options for bacterial conjunctivitis include sulfacetamide (Bleph-10, etc), erythromycin, bacitracin (AK-Tracin), bacitracin-polymyxin B (Polysporin), polymyxin B-neomycin-gramicidin (Neosporin), trimethoprim-polymyxin B (Polytrim), aminoglycosides (e.g., gentamicin, tobromycin, etc), quinolones (ciprofloxacin [Ciloxan], levofloxacin [Quixin], gatifloxacin [Zymar], etc), and azithromycin (AzaSite).

There are no significant differences between the clinical effects of various ophthalmic antibacterial agents used in patients with suspected acute bacterial conjunctivitis. The choice of treatment is based on ease of use, side-effects, bacterial susceptibility, and cost. In general, fewer daily doses yields better compliance to treatment.

Azithromycin ophthalmic solution (AzaSite) is dosed less frequently than other ophthalmic antibacterial agents (one drop twice daily for two days, then one drop daily for five days), but it is considerably more expensive and difficult to use. Fluoroquinolones are highly effective and well-tolerated; however, they are generally not used first-line for routine cases of bacterial conjunctivitis due to concerns of emerging resistance and cost. In general, agents that are less expensive with broad-spectrum coverage are used first-line for acute bacterial conjunctivitis (e.g., Polytrim, Polysporin, etc).


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