A ‘timely reminder’ that viral conjunctivitis is the most common eye infection so doesn’t require to antibiotics, has been given by Australian eye researchers.

The researchers, based at the University of Sydney’s Save Sight Institute, have published an article looking at treatment of common eye infections in the most recent issue of Australian Prescriber.

The article points out that not all red eyes are due to infections, and the most common eye infection is conjunctivitis, with most conjunctivitis cases viral so don’t require antibiotic drops.

The article, whose lead author was Professor Stephanie Watson, says there are no specific treatments for viral conjunctivitis and suggest health professionals advise patients to try cold compresses, artificial tears or topical antihistamines for comfort.

“Antibiotics are not needed, are costly and may increase antibiotic resistance,” says the article. Occasionally viral conjunctivitis is caused by herpes simplex or zoster virus and if the patient has  evidence of either of these viral infections than antivirals such as aciclovir ointment or ganciclovir gel should be prescribed.

The authors add that if viral conjunctivitis is severe, or the patient experiences symptoms after its resolution, the patient should be referred to an ophthalmologist. This is to consider topical steroids and to exclude an immune ‘post-viral’ keratitis.  Bacterial conjunctivitis, although a less frequent cause of conjunctivitis, is more common in children.

The authors also advised that urgent referral to an ophthalmologist for microbiological samples and treatment was needed for infection of the cornea (infectious keratitis) and the rare condition endophthalmitis (inflammation inside the eye).  Infectious keratitis is a cause of blindness and requires urgent specialist treatment. Infectious endophthalmitis is also an emergency – that the authors said had become more frequent with the use of intravitreal injections (for age-related macular degeneration) and cataract surgery – and intravitreal antibiotics were needed to try and prevent visual loss.

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