Most cases of pinkeye will heal without treatment and this will typically occur over the same time period as if treatment was administered. This must be considered when there are large numbers of animals affected, where catching and restraining animals is difficult, and where handling may stress animals and may predispose to other problems or increase the spread of pinkeye infection. There is a small risk of severely affected animals suffering long term effects or even permanent loss of eyesight.
However, correct treatment applied early in the disease when there is just epiphora and tear staining below the eye, may shorten the duration of disease and prevent the development of complications including permanent blindness and corneal scarring.
If there are concerns that grass seeds, chaff or other foreign bodies may be involved, then each affected animal should be restrained and undergo close examination of the eye, especially of the conjunctival sacs. Grass seeds and other foreign bodies are easier to remove if topical anaesthetic and forceps are used.
The treatment of choice for pinkeye is a parenterally administered course of antibiotics (oxytetracycline or trimethoprim sulpha) which should be repeated as necessary if signs persist. Injectable antibiotics are probably more effective than topical treatments because they are better able to achieve sustained therapeutic levels of antibiotic in the eye. Note that Mycoplasma are often involved in pinkeye in sheep and goats. Mycoplasma do not have a cell wall and therefore antibiotics that target bacterial cell wall synthesis (beta-lactam antibiotics such as penicillin and cloxacillin), are less likely to be effective.
A single topical application of long-acting, antibiotic eye ointment is commonly used in cattle. Both eyes should be treated even if only one eye is showing signs of disease. Animals may be re-treated at 48 hour intervals. These products often contain synthetic penicillins so may not be effective against Mycoplasma infections in pinkeye in sheep and goats.
Subconjunctival injection of antibiotic and anti-inflammatory drugs may be useful for individual animals with more severe disease and where good restraint is available to ensure safe administration of the treatment.
Severe cases must be handled carefully to prevent bumping the eye and the risk of corneal rupture. They may also benefit from applying an eye patch or suturing the eyelids closed for a period to provide protection while healing occurs.
Topical treatments with sprays and powders are not beneficial and may in fact be detrimental. The use of irritant chemicals in the eyes will cause damage to the cornea and will not help to treat or prevent infection. In large outbreaks, mass medication of drinking water with antibiotics may be attempted, but effectiveness is uncertain. This practice requires the installation of header tanks to achieve correct concentrations, the intake is variable with some animals not drinking enough, and it carries the risk of disrupting rumen function and feed intake.
Separate penning of severely affected animals with easy access to food and water may be warranted.