Pharmacology

Conjunctivitis—Allergic

Case Study

Patient Profile

Name: Gloria

Age: 47 years old

Gender: female

History of Present Illness

A 47-year-old woman, Gloria, presents to your office with complaints of a one-week history of red and itchy eyes. She has an associated mild burning sensation that waxes and wanes, a small amount of crusting in the morning, and clear watery drainage, not tan or thick. Gloria notes pressure in bilateral ears, nasal congestion, and sneezing. She expresses that her eyes are red like she stayed up all night, but she did not. This is her family’s second year at their new house. The same thing occurred last year when they started to use their heat and wood burning stove. She reports “I tried Visine moisture drops but that really has not helped.” Gloria does not wear contact lenses or glasses other than reading glasses with particularly small print.

Current Medications

Loratadine (Claritin) for seasonal allergies

Relevant Assessment

Denies fever, sick contacts, dizziness, eye pain other than the itching and slight burning sensation, and photophobia; there is no drainage in ears, sore throat, or cough.

Afebrile, hemodynamically stable, well oxygenated on room air.

HEENT: Atraumatic, normocephalic. Eyes: lids edematous, hyperemia, clear watery discharge, chemosis bilaterally. Ears: Canals clear, TMs intact, + serous effusions bilaterally; cone of light and bony landmarks visibile bilaterally; no purulent fluid levels, bulging, or retractions. Nose: pale nasal mucosa, mildly edematous nasal turbinates, clear rhinorrhea. Throat: non exudative 1+ tonsils bilaterally; non-exudative, non-erythematic midline uvula. Mild postnasal drip and cobblestone appearance.

Snellen chart results: OD: 20/20; OS: 20/20; OU: 20/20

No other expanded review of system (subjective data) or examination (objective data) has an impact on the diagnosis reviewed in this case.

Differentials

Conjunctivitis-allergic, viral, bacterial, corneal abrasion, viral keratitis, episcleritis, uveitis

Diagnosis

Conjunctivitis-allergic

Diagnostic testing

Fluorescence staining in the office does not find corneal abrasions.

Referrals

None at this time.

Patient/Provider Collaborative Goals

Gloria will experience relief of eye itching, watering, and burning sensation by time of planned follow-up.

Therapeutic Interventions

  1. Describe a first-line pharmacologic treatment: Include drug name, dose and formulation, frequency, and length of treatment at this dose.
    Answer:

    One option is olopatadine (Pataday) 0.2%: Instill one drop into each affected eye once daily.

    • Drug Mechanism of Action:
      Answer:

      Olopatadine (Pataday) is a histamine1 antagonist which inhibits the release of histamine from mast cells thereby limiting the impact of histamine on the conjunctiva.

    • Contraindications if applicable:
      Answer:

      Hypersensitivity to olopatadine or any components of the formulation. Additionally, olopatadine (Pataday) should not be utilized for irritation from contact lens use.

  1. Therapeutic advisement and monitoring: (include any specific instructions that apply, such as when to take the medication, if there are foods to avoid, storage issues, etc; include what laboratory/other (i.e., EKG) test monitoring to expect and how often and monitoring for adverse effects both common and serious)
    Answer:

    Specific Instructions: Instruct the patient to wash their hands prior to and after administration of eye drops. Educate the patient that treatment/relief for allergic conjunctivitis may require up to three weeks. Instruct the patient to use the eye drops until symptoms resolve or for up to three weeks. Counsel the patient that if they experience changes in their vision such as blurry vision, double vision, or floaters in visual field, or if they develop pus-like drainage, increasing redness, eye pain, nausea, vomiting, headache, or other neurological symptoms to seek medical care in the emergency department.

    • Therapeutic Monitoring: No special monitoring recommended.
    • Monitor side/adverse effects. Side/adverse effects are uncommon in general. The most noted side/adverse effects include cold symptoms including sore throat/pharyngitis.
    • Serious Adverse Effects: Not applicable.
  1. Planned follow-up should consider adverse effect monitoring, dose adjustment considerations, and decisions about continuing versus discontinuing. In this case, planned follow-up would be:
    Answer:

    Follow-up as needed.

Review Questions

Click the arrow to expand the section and view the correct answers.

  1. Which medication should be avoided if the underlying cause of conjunctivitis is not known?
    1. Fluoroquinolone antibiotic ophthalmic drops
    2. Corticosteroid ophthalmic drops
    3. Macrolide ophthalmic eye drops
    4. Aminoglycoside ophthalmic eye drops
Answer:

B. Corticosteroid ophthalmic drops

Feedback: Viral eye infections may worsen with the use of corticosteroid therapy if there is a lack of concomitant antimicrobial/antiviral therapy. Corticosteroid monotherapy, by interfering with immune function, may augment increased viral replication and deepen penetrating infection, thereby worsening patient outcomes.

  1. When treating patients for bacterial conjunctivitis, how long should you teach the patient that their condition is contagious after initiation of antimicrobial/antibiotic eye drops?
    1. 2-4 hours
    2. 4-8 hours
    3. 24-48 hours
    4. 48-72 hours
Answer:

C. 24-48 hours

Feedback: Antimicrobial/antibiotic intervention should be in place for a minimum of 24 hours before the patient is considered no longer contagious when being treated for bacterial conjunctivitis. Viral ocular infections may be transmitted as long as there are still symptoms.

  1. Which medication class is NOT appropriate for allergic conjunctivitis?
    1. Sulfonamide
    2. Mast cell stabilizer
    3. H1 blocker with mast cell stabilizing properties
    4. None of the above
Answer:

A. Sulfonamide

Feedback: Medication classes that are appropriate to use for allergic conjunctivitis include: Mast cell stabilizers (Cromolyn sodium [Cromolyn], Lodoxamide tromethamine [Alomide], Nedocromil sodium [Alocril]); H1 receptor blocker with mast cell stabilizing properties (alcaftadine [Lastacaft], azelastine) and others.

  1. What is the preferred treatment for bacterial conjunctivitis in a patient who wears contact lenses?
    1. Erythromycin ointment
    2. Doxycycline eye drops
    3. Polymyxin B/trimethoprim eye drops
    4. Ciprofloxacin eye drops
Answer:

D. Ciprofloxacin eye drops

Feedback: Contact lens wearers are more prone to infection with P. aeruginosa thus coverage for this bacterium is needed and can be accomplished with fluoroquinolone antibiotics like ciprofloxacin (Cipro) or ofloxacin. Be certain to check for keratitis, evidenced by opacity over the cornea when shining a penlight on the eye prior to treating the contact lens wearing patient with antibiotics. Keratitis requires a same day referral to ophthalmology.

  1. Viral conjunctivitis is treated with ganciclovir. (True or False)
    1. True
    2. False
Answer:

A. True

Feedback: Viral conjunctivitis may be treated with ganciclovir or trifluridine topically. Oral options may include acyclovir (Zovirax), valacyclovir (Valtrex), and others.

  1. Which of the following is a mast cell stabilizer appropriate for allergic conjunctivitis?
    1. Olopatadine hydrochloride
    2. Ofloxacin
    3. Cromolyn sodium
    4. Tobramycin
Answer:

C. Cromolyn sodium

Feedback: Some mast cell stabilizers available to treat allergic conjunctivitis include: cromolyn sodium (Crolom), lodoxamide tromethamine (Alomide), and nedocromil sodium (Alocril).

  1. Treatment for allergic conjunctivitis is needed for a maximum of seven days. (True or False)
    1. True
    2. False
Answer:

B. False

Feedback: Treatment for allergic conjunctivitis may require up to three weeks.

  1. You have a patient who wears contact lenses and needs treatment for bacterial conjunctivitis; you know the patient understands your instructions when the patient states:
    1. I can wear my contact lenses if I use a new pair right away
    2. I should not wear contact lenses until my treatment is complete and, at that point, I will use a new pair
    3. I can wear my same contacts if I use a non-expired cleaning solution
    4. I can wear contacts if I use a new pair every day for the first two days
Answer:

B. I should not wear contact lenses until my treatment is complete and, at that point, I will use a new pair

Feedback: Patients who are being treated for bacterial conjunctivitis who use contact lenses should not wear contact lenses until treatment is complete.

References

Hamrah, P. & Dana, R. (2025). Allergic conjunctivitis: Management. UpToDate®. Retrieved June 11, 2025 from https://www.uptodate.com/contents/allergic-conjunctivitis-management

Keenan J. D. (2023). Steroids in the management of infectious keratitis. Cornea, 42(11), 1333–1339. https://doi.org/10.1097/ICO.0000000000003340

Rhee, M. K., Ahmad, S., Amescua, G., Cheung, A. Y., Choi, D. S., Jhanji, V., Lin, A., Mian, S. I., Viriya, E. T., Mah, F. S., & Varu, D. M. (2023). Bacterial keratitis preferred practice pattern®. Ophthalmology, 131(4). https://doi.org/10.1016/j.ophtha.2023.12.035

Rosenthal, L. D., & Burchum, J. R. (2026). Drugs for disorders of the eye. In Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (3rd ed., pp. 819–829). Elsevier.

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Be Prepared for Your Nurse Practitioner Clinical Readiness Exam Copyright © 2026 by Elizabeth Heavey, Renee Biedlingmaier, Colleen Burgoyne and Carnel C. Jackson is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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