Most cases of pink eye (conjunctivitis) don’t require antibiotics

Mallika Marshall, MD
Mallika Marshall, MD, Contributing Editor

If you or your child has ever had acute conjunctivitis or “pink eye,” you know how nasty it can be.  “Crusty,” “goopy,” “bloodshot,” “itchy,” and “gritty” are all common words used to describe the eye condition that affects some six million people in the US every year.

What is conjunctivitis exactly?

Conjunctivitis is inflammation of the conjunctiva, which is the thin membrane that covers the whites of the eyes. There are three main types of conjunctivitis: allergic, viral, and bacterial.

  • Allergic conjunctivitis often accompanies other allergy symptoms like itchy, runny nose or sneezing.
  • Viral conjunctivitis is the most common and is triggered by the same viruses that cause the common cold. Therefore, it is usually accompanied by cold symptoms like runny nose and cough.
  • Bacterial conjunctivitis causes a thick discharge and responds to antibiotic eye drops or ointment.

Treating conjunctivitis

It can be hard to distinguish between viral and bacterial conjunctivitis simply by looking at it, so many doctors treat with a topical antibiotic “just in case” it is bacterial. However, according to ophthalmologists bacterial conjunctivitis often goes away on its own, and the practice of treating everyone “just in case” is irresponsible. A new study by the American Academy of Ophthalmology in the journal Ophthalmology shows just how big a problem the overuse of antibiotics for conjunctivitis has become.

Researchers looked at more than 340,000 enrollees in a large US managed care network with newly diagnosed acute conjunctivitis from 2001 through 2014. They found that almost 60% of the patients filled at least one prescription for a topical antibiotic.

White, more educated, and more affluent patients were more likely to fill antibiotic prescriptions, and the type of doctor making the diagnosis made a difference. Emergency room doctors, urgent care physicians, internists, and pediatricians were more likely to prescribe antibiotics than ophthalmologists.

Why routine antibiotics for conjunctivitis isn’t such a great idea

Overprescribing antibiotics, even topical ones like drops and ointments, can do more harm than good. Patients may suffer from side effects and allergic reactions to the medication. Parents are asked to administer unnecessary eye medication to an infant or child, which, believe me, can be incredibly challenging. And the inappropriate use of antibiotics continues to fuel resistance, making antibiotics less and less effective when we really need them.

As an urgent care physician, I know how hard it is to tell a patient or a parent that they have to wait for something to run its course. They want a quick fix and I want to provide it. And some schools won’t let a child with conjunctivitis return to class without proof they have been on an antibiotic for 24 hours. However, we have to educate schools and the public at large that most conjunctivitis is harmless and will go away on its own, and that most cases of conjunctivitis should not be treated with an antibiotic.

Here’s what you can do

There are some simple things you can do at home to ease your symptoms. Warm compresses can help loosen eyelid crusting. Cool compresses and artificial tears can soothe irritated eyes. Over-the-counter eye drops and antihistamines can help ease the itching and tearing associated with allergic conjunctivitis.

Bottom line: if you think you or your child has conjunctivitis, call your doctor’s office. They can often make recommendations over the phone, but don’t be surprised or upset if they say you don’t need a prescription. They are doing you and the public at large a favor.

Related Information: Controlling Your Allergies