From the Guidelines
Topical povidone-iodine (Betadine) is not recommended as a primary treatment for viral conjunctivitis, as there is no evidence supporting its efficacy in treating this condition. The most recent and highest quality study, published in 2024 in the journal Ophthalmology 1, does not mention the use of topical povidone-iodine as a treatment for viral conjunctivitis. Instead, the study emphasizes the importance of proper hygiene and education in preventing the transmission of epidemic adenoviral conjunctivitis.
Key Points to Consider
- The study highlights the economic impact of conjunctivitis, which is largely due to lost work or school time and the cost of medical visits, testing, and treatment 1.
- Chronic and/or recalcitrant conjunctivitis may be indicative of an underlying malignancy or inflammatory condition, and requires further investigation 1.
- The use of topical antibiotics or corticosteroids should be avoided, as they are not effective in treating viral conjunctivitis and may even be harmful 1.
Alternative Treatment Options
- Supportive measures such as cool compresses and artificial tears may be used to alleviate symptoms of viral conjunctivitis.
- Patients should be advised to practice good hygiene, including frequent hand washing and avoiding close contact with others during the period of contagion.
- Further medical evaluation is recommended if symptoms worsen or persist beyond a week.
Important Considerations
- The indiscriminate use of topical antibiotics or corticosteroids should be avoided, as they are not effective in treating viral conjunctivitis and may even be harmful 1.
- Gonococcal conjunctivitis is a hyperacute, vision-threatening infectious condition that requires immediate systemic therapy 1.
- Herpes zoster vaccination is strongly recommended in patients 50 years or older and patients 19 years or older who are immunocompromised 1.
From the FDA Drug Label
Warnings Do not use in eyes.
The FDA drug label does not answer the question.
From the Research
Efficacy of Topical Povidone-Iodine Treatment
- The efficacy of topical povidone-iodine (PVP-I) treatment for viral conjunctivitis has been studied in several trials 2.
- Low certainty evidence suggests that PVP-I alone resolves signs and symptoms by seven days relative to artificial tears 2.
- PVP-I or PVA-I, alone or with steroid, is associated with lower risks of subepithelial infiltrates (SEI) development than artificial tears or steroid (very low certainty evidence) 2.
- Topical povidone-iodine treatment has been shown to be effective in reducing the duration of symptoms and signs of epidemic keratoconjunctivitis (EKC), a highly contagious subset of adenoviral conjunctivitis 2.
Comparison with Other Treatments
- The evidence for the efficacy of topical povidone-iodine treatment compared to other treatments, such as antiviral agents or steroids, is limited and of low or very low certainty 2.
- Topical corticosteroids are useful in treating ocular inflammation, but most treatment guidelines recommend steroid use generally in severe cases of conjunctivitis due to potential risks associated with steroid use 3.
- Ophthalmic formulations that combine corticosteroids with broad-spectrum anti-infectives could be effective and well tolerated when used for short-term treatment (≤2 weeks) 3.
Safety and Adverse Effects
- Antiviral or antimicrobial agents plus steroid did not differ from artificial tears in terms of ocular discomfort upon instillation 2.
- CsA and tacrolimus eye drops were associated with more cases of severe ocular discomfort, and sometimes intolerance, when compared with steroids 2.
- Bacterial superinfection was rare and not associated with use of the intervention steroid 2.