Bacterial and Viral Conjunctivitis Treatment

Differentiate between bacterial and viral conjunctivitis

Bacterial and viral conjunctivitis often have similar symptoms, but they vary in terms of origin. Bacterial conjunctivitis is caused by a bacterial infection, whereas viral conjunctivitis is caused by viruses. It is also possible to differentiate between the two types of conjunctivitis based on the color of the discharge. According to the Association of Optometrists (2017), bacterial conjunctivitis results in a yellow or green sticky discharge, whereas viral conjunctivitis usually causes a clear, watery discharge. The two types of conjunctivitis also require different treatments (Association of Optometrists, 2017). Whereas antibiotic treatment is effective for bacterial conjunctivitis, it will not work on viral conjunctivitis.

Risk factors for bacterial conjunctivitis

Risk factors for bacterial conjunctivitis include demographic, health, and behavioral factors. First of all, bacterial conjunctivitis is more common in young children and older adults than in other population groups (Association of Optometrists, 2017). Other demographic risk factors for bacterial conjunctivitis include gender. As shown by Fernández-Rubio, Cuesta-Rodríguez, Urcelay-Segura, and Cortés-Valdés (2013), male sex is associated with increased conjunctival bacteria, which could lead to conjunctivitis. Health risk factors include diabetes, lung diseases, renal and heart insufficiency, and kyphoscoliosis, as well as eye surgery (Fernández-Rubio et al., 2013). Behavioral factors that can influence the development of bacterial conjunctivitis include personal hygiene. For example, as noted by the Association of Optometrists (2017), bacterial conjunctivitis is highly contagious, so sharing a towel with other people can be lead to infection. Other personal hygiene habits, such as not washing hands regularly, can also contribute to bacterial conjunctivitis.

Treatment modalities for both conjunctivitis with guidelines

The preferred treatment plan depends on the type of conjunctivitis present in the patient. According to the guidelines of the American Academy of Ophthalmology, establishing the nature of bacterial or viral conjunctivitis is crucial to defining the treatment. Adenoviral conjunctivitis is normally self-limiting, but it may be necessary to prescribe treatment for relieving the symptoms. Topical corticosteroids, artificial tears, and antihistamines are used to contain the symptoms of adenoviral conjunctivitis. Viral conjunctivitis caused by herpes simplex should be treated topically with ganciclovir 0.15% gel applied 3-5 times a day for one week, although the treatment can be prolonged after a follow-up visit (Feder et al., 2013). Alternatively, oral valacyclovir 500 mg or famciclovir 250 mg can be taken twice daily (Feder et al., 2013).

Bacterial conjunctivitis can also be self-limited, but if the symptoms do not improve after one week, antibiotic treatment should be considered. First, it is critical to obtain a culture test to determine if the infection is triggered by gonococcus or chlamydia (Azari & Barney, 2013). Gonococcal bacterial conjunctivitis is treated with ceftriaxone 250mg (single dose) and azithromycin 1 g (single dose) or doxycycline 100 mg twice daily for seven days (Feder et al., 2013). Chlamydial conjunctivitis is treated with a single dose of 1 g azithromycin or doxycycline 100 mg twice daily for seven days (Feder et al., 2013). The same treatments can be used in children as long as the dosages are appropriate to age and weight.

Discharge and patient education with guidelines

Conjunctivitis is normally managed in outpatient settings, and thus patients diagnosed with conjunctivitis can be discharged immediately. A follow-up visit should be scheduled in 1-3 weeks depending on the symptoms and the type of infection found in the patient. Patient education should include information about the treatment and follow-up schedule, as well as proper eye hygiene. According to Feder et al. (2013), patients should be advised to wash their hands with antibacterial soap and use separate towels both at home and at work. Moreover, patient education should also address the importance of regular eye screening and encourage the patient to visit a doctor in case of recurrent symptoms of conjunctivitis (Feder et al., 2013). Overall, appropriate treatment supplemented by patient education can help in treating and preventing both bacterial and viral conjunctivitis in children and adults.


Association of Optometrists. (2017). Bacterial and viral conjunctivitis. Web.

Azari, A. A., & Barney, N. P. (2013). Conjunctivitis: A systematic review of diagnosis and treatment. JAMA, 310(16), 1721-1730.

Feder, R. S., McLeod, S. D., Akpek, E. K., Dunn, S. P., Garcia-Ferrer, F. J., Lin, A.,… Musch, D. C. (2013). American Academy of Ophthalmology conjunctivitis preferred practice pattern guidelines – 2013. Web.

Fernández-Rubio, M. E., Cuesta-Rodríguez, T., Urcelay-Segura, J. L., & Cortés-Valdés, C. (2013). Pathogenic conjunctival bacteria associated with systemic co-morbidities of patients undergoing cataract surgery. Eye, 27(8), 915-923.