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Ophthalmic medications for the treatment of bacterial and viral (non-allergic) conjunctivitis*

Ophthalmic medications for the treatment of bacterial and viral (non-allergic) conjunctivitis*
  Dose (each affected eye)
Bacterial conjunctivitis
Patients who do NOT wear contact lenses (select one):
  • Erythromycin 5 mg/gram ophthalmic ointment (preferred)
 0.5 inch (1.25 cm) 4 times daily for 5 days
  • Trimethoprim-polymyxin B 0.1%-10,000 units/mL ophthalmic drops (preferred)
 1 to 2 drops 4 times daily for 5 days
  • Bacitracin-polymyxin B 500 units-10,000 units/gram ophthalmic ointment (alternative)
 0.5 inch (1.25 cm) 4 times daily for 5 days
  • Bacitracin 500 units/gram ophthalmic ointment (alternative)
 0.5 inch (1.25 cm) 4 times daily for 5 days
  • Azithromycin 1% ophthalmic drops (alternative)
 1 drop 2 times daily for 2 days; then 1 drop once daily for 5 days
  • Fusidic acid 1% ophthalmic suspension (alternative; not available in the United States)
 1 drop 2 times daily for 5 days
  • Chloramphenicol 0.5% ophthalmic drops (alternative, not available in the United States)
 1 drop 4 times daily for 5 days; use during waking hours only
Contact lens wearers (select one):
  • Ofloxacin 0.3% ophthalmic drops
 1 to 2 drops 4 times daily for 5 days
  • Ciprofloxacin 0.3% ophthalmic drops)
 1 to 2 drops 4 times daily for 5 days
  • Ciprofloxacin 0.3% ophthalmic ointment
 0.5 inch (1.25 cm) 4 times daily for 5 days
Viral conjunctivitis
  • Antihistamine-decongestant combination drops (OTC)Δ
    • Naphazoline-pheniramine
 1 to 2 drops up to 4 times daily as needed for up to 2 weeks
or
  • Antihistamines with mast-cell stabilizing properties (OTC)Δ
    • Including: Alcaftadine, ketotifen, olopatadine (others available by prescription)
 1 drop once or twice daily (refer to product-specific directions)
and/or
  • Eye lubricant drops and/or ointments (OTC)◊

Drops: 1 to 2 drops up to 6 times daily as needed

Ointment: 0.5 inch (1.25 cm) at bedtime or 4 times daily as needed
Viral conjunctivitis symptoms may worsen for the first 3 to 5 days and gradually improve over the following 1 to 2 weeks.
For use with UpToDate content on conjunctivitis. Some clinical presentations warrant prompt urgent referral to an ophthalmologist; "red flags" may include reduced visual acuity, photophobia, severe headache with nausea, worsening symptoms after one day, or no response within a few days (except viral conjunctivitis which may worsen for 3 to 5 days); for additional warning signs refer to topic. Ophthalmic corticosteroids (alone or in combination drops) are not recommended unless treatment is guided by an ophthalmologist. The dosage regimens listed above may differ from the manufacturer's recommendations.

OTC: over-the-counter (available without a prescription in the United States).

* For the management of allergic conjunctivitis, refer to separately available clinical topic and table in UpToDate.

¶ Remove contact lenses for the duration of therapy; used lenses and lens case should be discarded. If there is any corneal opacity or suspicion of keratitis, the patient should be evaluated by an ophthalmologist. Patient can resume contact lens wear when the eye is white and has no discharge for 24 hours after completion of treatment. Other available ophthalmic fluoroquinolones include levofloxacin 1.5% and moxifloxacin 0.5%.

Δ Antihistamine/decongestant drops or antihistamine/mast cells stabilizer drops may be helpful, particularly if itching is a prominent symptom, but should be discontinued if symptoms worsen.

◊ OTC eye lubricants include: Polyethylene glycol, propylene glycol, glycerin, and others.

Courtesy of Deborah S Jacobs, MD, with additional data from: Gervasio KA, Peck T. Conjunctiva/sclera/iris/external disease. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 8th ed, Lippincott Williams & Wilkins 2021.
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