What is the treatment for viral conjunctivitis?

Treatment of Viral Conjunctivitis

Most cases of viral conjunctivitis are self-limited and do not require specific antiviral treatment; management focuses on supportive care with artificial tears, cold compresses, and patient education about preventing transmission. 1

Types of Viral Conjunctivitis and Their Management

Adenoviral Conjunctivitis (Most Common)

• Self-limited condition requiring primarily supportive care:

  • Artificial tears for lubrication
  • Cold compresses for symptom relief
  • Topical antihistamines to reduce itching
  • Oral analgesics for discomfort
  • Avoid antibiotics as they provide no benefit 1

• For severe cases with marked chemosis, lid swelling, or membranous conjunctivitis:

  • Topical corticosteroids at minimum effective dose may reduce symptoms and scarring
  • Close monitoring required as steroids may prolong viral shedding
  • Taper once inflammation is controlled 1

• For subepithelial infiltrates causing visual symptoms:

  • Topical corticosteroids with poor ocular penetration (fluorometholone, loteprednol)
  • Cyclosporine drops (0.05%-1%) as steroid-sparing alternative 1

• Patient education is crucial:

  • Highly contagious for 10-14 days from symptom onset
  • Frequent handwashing
  • Avoid touching eyes
  • Avoid sharing towels, pillows, or makeup 2, 3

Herpes Simplex Virus Conjunctivitis

• Requires prompt treatment unlike adenoviral conjunctivitis:
  • Topical options: ganciclovir 0.15% gel (3-5 times daily) or trifluridine 1% solution (5-8 times daily)
  • Oral options: acyclovir (200-400mg five times daily), valacyclovir (500mg 2-3 times daily), or famciclovir (250mg twice daily)
  • Combination of topical and oral therapy is most effective 1, 4
  • Avoid topical corticosteroids as they potentiate HSV epithelial infections 1

Varicella Zoster Virus Conjunctivitis

• For persistent/recalcitrant cases:
  • Oral antivirals: acyclovir (800mg five times daily for 7 days), valacyclovir (1000mg every 8 hours for 7 days), or famciclovir (500mg three times daily for 7 days)
  • Topical antibiotics may be used to prevent secondary bacterial infection
  • Topical antivirals alone are not effective but may be added in unresponsive cases 1

Molluscum Contagiosum-Associated Conjunctivitis

• Treatment targets the eyelid lesions:
  • Incision and curettage
  • Simple excision
  • Excision and cautery
  • Cryotherapy 1

Follow-up Recommendations

• Severe cases with corneal epithelial ulceration or membranous conjunctivitis: re-evaluate within 1 week
• Patients on topical corticosteroids: monitor IOP and pupillary dilation periodically
• Without corticosteroid treatment: return if symptoms persist after 2-3 weeks 1

Special Considerations

• Neonatal HSV conjunctivitis: requires immediate pediatric consultation as systemic infection is life-threatening 1
• Immunocompromised patients: may need more aggressive treatment 1
• Patients with history of adenoviral infection: caution with photorefractive keratectomy or LASIK due to risk of recurrent subepithelial infiltrates 1

Common Pitfalls to Avoid

• Using antibiotics for viral conjunctivitis (ineffective and may cause adverse effects)
• Using topical corticosteroids in HSV epithelial infections
• Failing to recognize HSV conjunctivitis, which requires specific antiviral treatment
• Inadequate patient education about contagion period and hygiene measures
• Insufficient follow-up for patients with severe disease or on corticosteroid therapy 1, 2