Treatment of conjunctivitis in the 21st century Review article

Main Article Content

Marek Edmund Prost


One of the reasons for the development of antibiotic resistance in ophthalmology is the indiscriminate use of antibiotics in the treatment of conjunctivitis, among other things. Therefore, in infectious conjunctivitis, the first-line treatment should be antiseptics rather than antibiotics. This should significantly reduce the development of antibiotic resistance, but also increase the effectiveness of treatment.


Download data is not yet available.

Article Details

How to Cite
Prost ME. Treatment of conjunctivitis in the 21st century. Ophthatherapy [Internet]. 2024Mar.31 [cited 2024Jul.18];11(1):47-3. Available from:
Conservative treatment


1. Chang Q, Wang W, Regev-Yochay G et al. Antibiotics in agriculture and the risk to human health: how worried should we be? Evolutionary Applications. 2015; 8: 240-7.
2. Antimicrobial Resistance Collaborators: Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022; 399: 629-55.
3. Milder E, Vander J, Shah C et al. Changes in antibiotic resistance patterns of conjunctival flora due to repeated use of topical antibiotics after intravitreal injection. Ophthalmology. 2012; 119(7): 1420-4.
4. Grosso A, Bandello F, Ceruti P et al. Choosing wisely: Antibiotic use in ophthalmic surgery. Rethinking the use of antibiotics before and after surgery. Special Report. Retina Today. 2019; March: 48-53.
5. Grzybowski A, Koerner JC, George MJ. Postoperative endophthalmitis after cataract surgery: A worldwide review of etiology, incidence and the most studied prophylaxis measures. Expert Rev Ophthalmol. 2019; 14(4-5): 247-57.
6. Prost M, Semczuk K. Antybiotykooporność szczepów bakteryjnych worka spojówkowego u dzieci. Klin Oczna. 2005; 107: 418-20.
7. Grzybowski A, Brona P, Kim SJ. Microbial flora and resistance in ophthalmology: a review. Graefes Arch Clin Exp Ophthalmol. 2017; 255: 851-62.
8. Prost M. Antibiotic therapy of bacterial conjunctivitis – a practical approach. Ophthatherapy. 2021; 8: 240-6.
9. Hwang DG. Fluoroquinolone resistance in ophthalmology and the potential role for newer ophthalmic fluoroquinolones. Surv Ophthalmol. 2004; 49(suppl 2): S79-83.
10. Blondeau JM. Fluoroquinolones: Mechanism of action, classification, and development of resistance. Surv Ophthalmol. 2004; 49(suppl 2): S73-8.
11. Filipek B, Prost M. Leki stosowane w leczeniu chorób infekcyjnych oczu. In: Prost M, Jachowicz R, Nowak JZ (ed). Kliniczna farmakologia okulistyczna. 2 ed. Elsevier, Wrocław 2016.
12. Rose PW, Harnden A, Brueggemann AB et al. Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double‑blind placebo‑controlled trial. Lancet. 2005; 366: 37-43.
13. Honkila M, Koskela U, Kontiokari T et al. Effect of topical antibiotics on duration of acute infective conjunctivitis in children: a randomized clinical trial and a systematic review and meta‑analysis. JAMA Network Open. 2022; 5(10): e2234459.
14. Chen YY, Liu AHS, Nurmatov U et al. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. 2023; 3: CD001211. 10.1002/14651858.CD001211.pub4.
15. Prost M, Szot M, Dudek D et al. Wiarygodność stosowania leków jako problem terapeutyczny w leczeniu jaskry w Polsce. Okulistyka. 2009; 1: 26-9.
16. Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identifcation of risk factors. J Cataract Refract Surg. 2007; 33: 978‑88.
17. Barry P, Cordovés L, Gardner S. ESCRS guidelines for prevention and treatment of endophthalmitis following cataract surgery: Data, dilemmas and conclusions. Eur Soc Cataract Refract Surg Dublin 2013.
18. Grzybowski A, Kupidura-Majewski K. Znaczenie kropli antybiotykowych w profilaktyce okołooperacyjnej zapalenia wnętrza gałki po operacjach zaćmy. Ophthatherapy. 2019; 6(3): 147-51.
19. Kanclerz P, Myers WG. Chlorhexidine and other alternatives for povidone-iodine in ophthalmic surgery: review of comparative studies. J Cataract Refract Surg. 2022; 48: 363-9.
20. Borgia A, Mazucca D, Della Corte M et al. Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management. Ophthalmol Ther. 2023; 12: 721-34.
21. Szumny D. Will antiseptics become the standard in ophthalmology in the future? Ophthatherapy. 2023; 10(3): 190-4.
22. Kanclerz P, Myers WG. Potential substitutes for povidone-iodine in ocular surgery. Eye. 2021; 35: 2657-9.
23. Parikh SR, Parikh RS. Chemical disinfectants in ophthalmic practice. Indian J Ophthalmol. 2021; 69: 510-6.
24. Koburger T, Hübner H-N, Braun M et al. Standardized comparison of antiseptic efficacy of triclosan, PVP iodine, octenidine dihydrochloride, polyhexanide and chlorhexidine digluconate. J Antimicrob Chemother. 2010; 65(8): 1712-9.
25. Ferrara M, Gatti F, Lockington D et al. Antimicrobials and antiseptics: Lowering effect on ocular surface bacterial flora – A systematic review. Acta Ophthalmologica. 2023; 00: 1-14.
26. Spadea J, Zanotto E, Cavallo R et al. Effectiveness of liposomal ozonized oil in reducing ocular microbial flora in patients undergoing cataract surgery. J Cataract Refract Surg. 2021; 47(12): 1548-55.
27. Caruso I, Eletto D, Tosco A et al. Comparative Evaluation of Antimicrobial, Antiamoebic and Antiviral Efficacy of Ophthalmic Formulations. Microorganisms. 2022; 10(6): 1156.
28. Romano V, Ferrara M, Aragona E et al. Topical antiseptics in minimizing ocular surface bacterial load before ophthalmic surgery: a randomized controlled trial. Am J Ophthalmol. 2024; 261: 165-75.
29. Pinna A, Gavino Donadu M, Usai D et al. In Vitro Antimicrobial Activity of a New Ophthalmic Solution Containing Hexamidine Diisethionate 0.05% (Keratosept). Cornea. 2020; 39(11): 1415-9.
30. Lachota M, Hautz W. Ocusept jako potencjalna alternatywa dla antybiotyków w leczeniu ostrego infekcyjnego zapalenia spojówek u dzieci. Standardy Medyczne/Pediatria. 2023; 20: 575-8.
31. Isenberg J, Apt L, Valenton M et al. A controlled trial of povidone-iodine to treat infectious conjunctivitis in children. Am J Ophthalmol. 2002; 134(5): 681-8.
32. Pepose JS, Ahuja A, Narvekar A et al. Randomized, Controlled, Phase 2 Trial of Povidone Iodine/Dexamethasone Ophthalmic Suspension for Treatment of Adenoviral Conjunctivitis. Am J Ophthalmol. 2018; 194(10): 7-15.
33. Pepose JS, Narvekar A, Liu W et al. A randomized controlled trial of povidone-iodine/dexamethasone ophthalmic suspension for acute viral conjunctivitis. Clin Ophthalmol. 2019; 13: 535-44.