Bacterial Conjunctivitis Treatment in Adolescents

Diagnosis and Treatment

• The American Academy of Ophthalmology recommends examining the cornea with fluorescein staining to detect corneal involvement, which would require more aggressive therapy 2
• If copious purulent discharge, severe pain, or marked inflammation is present, obtain conjunctival cultures and Gram stain to rule out gonococcal conjunctivitis, which requires systemic antibiotics (ceftriaxone 125 mg IM plus azithromycin 1 g PO) 3, 1
• Consider sexual abuse in any adolescent with gonococcal or chlamydial conjunctivitis, as these are sexually transmitted infections 3, 1

Patient Counseling and Referral

• Practice strict hand hygiene to prevent transmission to others or the unaffected eye, and avoid sharing towels 4
• Immediate referral to an ophthalmologist is warranted for visual loss or moderate-to-severe pain, severe purulent discharge suggesting gonococcal infection, corneal involvement on fluorescein staining, lack of response after 3-4 days of appropriate therapy, history of immunocompromise, or recurrent episodes or history of HSV eye disease 4