Bacterial conjunctivitis is typically treated with antibiotic eye drops or ointment, though mild cases often clear on their own within a week. Antibiotics shorten the illness by roughly two days and reduce the chance of spreading it to others. Most people see improvement within the first few days of treatment, with full resolution in about a week.
How to Tell It’s Bacterial
The hallmark of bacterial conjunctivitis is a thick, yellow or green discharge that causes your eyelids to stick together, especially when you wake up. Viral conjunctivitis, by contrast, tends to produce a thinner, watery discharge and often accompanies a cold or upper respiratory infection. Both types cause redness and irritation, but the gluey, crusty discharge points toward bacteria.
Getting this distinction right matters because antibiotics do nothing for viral conjunctivitis, which is far more common. The American Academy of Ophthalmology explicitly warns against indiscriminate use of topical antibiotics, noting that viral cases won’t respond and mild bacterial cases are likely to resolve without treatment.
Antibiotic Drops and Ointments
No single topical antibiotic has been shown to work better than any other for routine bacterial conjunctivitis. The choice usually comes down to cost, convenience, and whether drops or ointment is preferred.
The most commonly prescribed, budget-friendly options include:
- Trimethoprim/polymyxin B drops: applied every three hours for 7 to 10 days
- Erythromycin ointment: applied four times a day for 5 to 7 days
- Sulfacetamide drops: applied every two to three hours initially, then tapered to twice daily as symptoms improve
More expensive alternatives include fluoroquinolone drops like moxifloxacin or ofloxacin, which are typically reserved for more severe infections or when a first-line option doesn’t work. Azithromycin drops offer a shorter, simpler dosing schedule (twice daily for two days, then once daily for five days), which can be easier to stick with.
Ointments blur your vision temporarily after application, so many adults prefer drops during the day. For young children, though, ointment is often easier to administer and stays on the eye longer. Erythromycin ointment is safe for infants and is the same antibiotic used in newborns to prevent eye infections at birth.
How Quickly Antibiotics Work
A randomized trial comparing antibiotic drops to placebo in children found that the average time to full resolution was 3.8 days with antibiotics, 4.0 days with placebo drops, and 5.7 days with no treatment at all. The takeaway: antibiotics provide a modest speed advantage over doing nothing, but the infection resolves either way. The bigger benefit of antibiotics is reducing how contagious you are and preventing rare complications like corneal inflammation.
You should notice less discharge and reduced redness within the first 24 to 48 hours. If symptoms worsen or don’t improve after two to three days of treatment, contact your prescriber. A different antibiotic or a reassessment of the diagnosis may be needed.
Supportive Care at Home
Whether or not you’re using antibiotics, a few simple steps at home make a real difference in comfort and healing.
To loosen the crusty buildup on your eyelids, soak a clean washcloth in warm water, wring it out, and lay it over your closed eyes until it cools. Repeat several times a day as needed. Use a fresh washcloth each time, and if both eyes are infected, use a separate cloth for each eye. This prevents reinfecting the same eye or spreading bacteria to the other one.
Artificial tears (preservative-free if possible) can soothe the gritty, irritated feeling. Avoid touching or rubbing your eyes, and wash your hands thoroughly before and after applying drops or ointment. Don’t share towels, pillowcases, or eye makeup with anyone in your household.
What to Do About Contact Lenses
Stop wearing contact lenses as soon as symptoms appear and don’t resume until the infection has fully cleared. Throw away any disposable lenses and lens cases you used while your eyes were infected, since bacteria can linger on these surfaces. If you wear reusable or extended-wear lenses, clean and disinfect them thoroughly before wearing them again. Your eye care provider can confirm when it’s safe to go back to your lenses.
Work, School, and Contagion
Bacterial conjunctivitis spreads through direct contact with infected discharge, contaminated hands, or shared personal items. The CDC advises staying home from work or school if you have conjunctivitis with systemic signs of illness (fever, for example) or if you can’t avoid close contact with others. Most schools and workplaces allow return once antibiotic treatment has been started and symptoms are clearly improving.
When the Infection Needs Urgent Attention
Most bacterial conjunctivitis is a nuisance, not a danger. But certain symptoms signal something more serious. Seek prompt care if you experience eye pain (not just irritation), blurred vision that doesn’t clear with blinking, intense sensitivity to light, or the feeling that something is stuck in your eye. These can indicate corneal involvement or a more aggressive infection.
One particularly aggressive form, gonococcal conjunctivitis, produces a rapid onset of severe swelling and heavy discharge. It is a vision-threatening emergency that requires systemic antibiotics (not just eye drops) and immediate medical evaluation. This type is rare in adults but can occur in sexually active individuals or in newborns exposed during delivery.