Conjunctivitis 101

MAY 03, 2018
Jennifer Gershman, PharmD
Conjunctivitis, commonly referred to as pink eye, involves inflammation of the outer layer of the eye and inside of the eyelid. Common causes include viruses, bacteria, allergens, contact lenses, fungi, and certain diseases.1  Viral and bacterial conjunctivitis can spread quickly among young children in daycare and school settings but can also occur in adults.  Pharmacists can play an important role in patient education.

Conjunctivitis Symptoms
Redness in one or both eyes is one of the hallmark symptoms of conjunctivitis.  Other symptoms include conjunctiva swelling; increased tear production; foreign body sensation in the eye; itching, irritation, and/or burning; discharge (pus or mucus); crusting of eyelids or lashes (especially in the morning); and contact lenses that feel uncomfortable.2

Causes
The most common causes of conjunctivitis are viral, bacterial, and allergic (Table 1).  The exact cause can be difficult to determine since the symptoms can be similar.



Treatment Strategies
Educate patients to consult an ophthalmologist or optometrist if they have conjunctivitis along with the following symptoms and conditions: eye pain; sensitivity to light or blurred vision; intense eye redness; worsening symptoms or no improvement; immunocompromised; pre-existing eye conditions.  Viral conjunctivitis will generally resolve within 7-14 days without treatment, but artificial tears, antihistamines, and cold compresses can be used for supportive care.5  Educate patients that antibiotics are not effective against viral conjunctivitis and can lead to resistance.  Antiviral medications may be prescribed for more serious forms of viral conjunctivitis caused by herpes simplex virus and varicella-zoster virus.  Bacterial conjunctivitis may resolve on its own without antibiotics within one to two weeks.5  However, topical antibiotics may shorten the duration of symptoms, prevent transmission, and reduce the risk of complications. 

Studies have demonstrated that all broad-spectrum antibiotic ophthalmic medications are effective, and there are no significant differences.5  Treatment options include aminoglycosides, fluoroquinolones, macrolides, and sulfonamides.  As part of hospital protocol for newborns to prevent neonatal conjunctivitis that may be caused by the delivery process, erythromycin ophthalmic ointment is generally given.6  Pharmacists should always verify that they have a complete history of patients’ allergies to ensure that an appropriate antibiotic is selected.  Topical steroids should be avoided for bacterial conjunctivitis, as these can potentially prolong the disease duration.5  Allergic conjunctivitis can be treated with topical antihistamines, oral antihistamines, and topical mast cell inhibitors.  Patients with CLPC should discontinue wearing the contact lenses until the symptoms have disappeared, and mast cell stabilizers and antihistamines can be used for treatment.4  Switching to a different type of contact lens may also help patients.

Preventing Transmission
Pharmacists, especially those practicing in the community setting, can play an important role in counseling patients on preventing transmission of viral and bacterial conjunctivitis.  Many child care facilities and schools require that children wait to return until at least 24 hours after starting treatment (Table 2).1 


 
Jennifer Gershman, PharmD, CPh is a pharmacist and Pharmacy Times contributor residing in South Florida.

References
  1. Centers for Disease Control and Prevention.  Conjunctivitis (pink eye). https://www.cdc.gov/conjunctivitis/.  Accessed February 22, 2018.
  2. Mayo Clinic.  Pink eye (conjunctivitis).  https://www.mayoclinic.org/diseases-conditions/pink-eye/symptoms-causes/syc-20376355.  Accessed February 23, 2018.
  3. American Academy of Ophthalmology.  Conjunctivitis.  http://eyewiki.aao.org/Conjunctivitis.  Accessed February 23, 2018.
  4. Alipour F, Khaheshi S, Soleimanzadeh M, et al.  Contact lens-related complications:  a review.  J Ophthalmic Vis Res.  2017; 12(2):193-204.
  5. Azari AA, Barney NP.  Conjunctivitis.  JAMA.  2013;310(16):1721-1729.
  6. Centers for Disease Control and Prevention.  Conjunctivitis (pink eye) in newborns.  https://www.cdc.gov/conjunctivitis/newborns.html.  Accessed February 26, 2018.


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