What are the systemic viruses that cause conjunctivitis and how are they managed?

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Last updated: June 22, 2025View editorial policy

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From the Guidelines

Systemic viruses that cause conjunctivitis include adenovirus, herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), measles, mumps, rubella, influenza, and enterovirus, and management primarily involves supportive care while the viral infection resolves naturally, with specific antiviral treatments indicated for certain viruses, such as HSV conjunctivitis requiring topical antivirals like trifluridine 1% drops or ganciclovir 0.15% gel, as recommended by the most recent study 1.

Key Considerations

  • The management approach differs based on the specific virus because each has unique pathophysiology and potential complications.
  • For symptomatic relief, artificial tears and cold compresses can be used to reduce inflammation and discomfort.
  • Specific antiviral treatments are indicated for certain viruses, such as:
    • HSV conjunctivitis: topical antivirals like trifluridine 1% drops (Viroptic) 9 times daily or ganciclovir 0.15% gel (Zirgan) 5 times daily for 7-10 days, as recommended by 1.
    • VZV: oral antivirals like acyclovir 800mg five times daily for 7-10 days, as recommended by 1.

Prevention and Public Health

  • Patients should be advised about the highly contagious nature of viral conjunctivitis, with strict hand hygiene, avoiding sharing personal items, and staying home from work or school until symptoms improve, typically within 1-2 weeks.
  • Vaccination strategies, such as the herpes zoster vaccine, can help prevent certain types of viral conjunctivitis, as recommended by 1.
  • Early diagnosis and treatment of infectious conjunctivitis is important to reduce the public health and economic impact of community spread, as highlighted by 1.

From the Research

Systemic Viruses that Cause Conjunctivitis

  • Adenovirus, enterovirus, and herpes virus are common causative agents of viral conjunctivitis, with adenoviruses accounting for approximately 80% of cases 2, 3.
  • Other systemic viruses that can cause conjunctivitis include Coxsackievirus A16 and A24, Enterovirus 70 and 71 3.
  • The diagnosis of viral conjunctivitis is usually based on clinical findings and medical history, but laboratory testing such as real-time PCR can be used to detect specific viral agents 3.

Management of Systemic Viruses that Cause Conjunctivitis

  • There is no established treatment for viral conjunctivitis, but antiviral medications such as aciclovir, trifluridine, and valaciclovir can be used to treat herpesvirus infections 4.
  • Cidofovir has been used to treat some cases of adenoviral conjunctivitis, but toxicity has also been reported 4.
  • Treatment of viral conjunctivitis focuses on relieving symptoms, and caution should be exercised when coadministering other pharmacological agents such as corticosteroids due to potential adverse effects 4, 5.
  • Accurate diagnosis and specific treatment of conjunctivitis remain challenging, and laboratory testing may play a vital role in identification of specific pathogen(s) 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Viral Conjunctivitis.

Viruses, 2023

Research

Molecular identification of viral agents associated with acute conjunctivitis: a prospective controlled study.

The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases, 2017

Research

Acute conjunctivitis: truth and misconceptions.

Current medical research and opinion, 2009

Research

Conjunctivitis: systematic approach to diagnosis and therapy.

Current infectious disease reports, 2011

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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