Conjunctivitis Treatment Guidelines

Introduction to Conjunctivitis

The American Academy of Ophthalmology does not recommend routine prophylactic treatment of the second eye in cases of unilateral, uncomplicated bacterial conjunctivitis 1, 2
Symptoms of viral conjunctivitis resolve spontaneously within 5-14 days 1

Newborns with conjunctivitis require immediate systemic antibiotic treatment to rule out gonococcal and chlamydial causes 3
Newborns with gonococcal conjunctivitis are at risk of sepsis, meningitis, and death 3
Individuals with compromised immune systems are at higher risk of severe complications and atypical presentations, and may require more aggressive treatment 3

Gonococcal conjunctivitis is a medical emergency requiring immediate systemic antibiotic treatment, and can cause corneal perforation within 24-48 hours 3
Chlamydial conjunctivitis requires aggressive systemic antibiotic treatment, and can cause inclusion bodies on the conjunctiva and cornea 2, 4
Chlamydial conjunctivitis in newborns can occur 5-19 days after birth, and up to 50% may have concurrent nasopharyngeal, genital, or pulmonary infection 2

Always examine the cornea with fluorescein staining to detect early corneal involvement in cases of purulent conjunctivitis 3
Gonococcal conjunctivitis often starts with corneal infiltration or ulceration in the upper part of the cornea, which can lead to perforation 2, 4
Significant eyelid swelling with copious purulent discharge should raise suspicion for gonococcal conjunctivitis 2, 4

Educate patients on frequent handwashing to prevent transmission of infection to the second eye 4
Avoid sharing towels, bedding, and cosmetics to prevent transmission of infection 4
Chlamydia trachomatis is highly infectious through hand contact, fomites, flies, and other contact 2, 4