Treatment of Viral Conjunctivitis
Viral conjunctivitis is generally self-limiting and primarily requires supportive care rather than specific antiviral treatment. 1
Diagnosis and Clinical Features
- Viral conjunctivitis accounts for approximately 80% of all acute conjunctivitis cases 2
- Key clinical features:
Management Approach
Primary Treatment: Supportive Care
- Artificial tears for lubrication
- Cold compresses to reduce inflammation
- Oral analgesics for discomfort
- Topical antihistamines for itching relief 1
Important Precautions
- Avoid indiscriminate use of topical antibiotics or corticosteroids as viral conjunctivitis will not respond to antibacterial agents 4
- Corticosteroids should generally be avoided as they are ineffective against viruses and may cause adverse effects 1
Special Considerations
- For cases with subepithelial infiltrates (developing 1+ weeks after onset) that cause blurred vision or photophobia, minimal effective dose topical corticosteroids may be considered 1
- In cases of membranous conjunctivitis, debridement of membranes may be necessary to prevent corneal epithelial abrasions 1
- For herpes simplex viral conjunctivitis, antiviral treatment may be required (e.g., ganciclovir 0.15% gel) 1
Prevention of Transmission
Viral conjunctivitis is highly contagious. The ophthalmologist plays a critical role in breaking the chain of transmission through patient education 4:
- Advise patients to minimize contact with others for 10-14 days from symptom onset 1
- Instruct on frequent handwashing
- Recommend using separate towels and pillows
- Avoid sharing personal items like cosmetics 1
- Proper disinfection of surfaces (viruses can survive for weeks on surfaces) 1
When to Refer to Ophthalmology
Refer patients with:
- Severe pain
- Decreased vision
- Symptoms persisting beyond 2-3 weeks
- Neonatal conjunctivitis
- Immunocompromised state
- Recent ocular surgery
- Vesicular rash on eyelids or nose
- History of rheumatologic disease 3
Important Cautions
- Chronic/recalcitrant conjunctivitis may indicate underlying malignancy (sebaceous carcinoma, lymphoma, squamous cell carcinoma) or inflammatory conditions 4
- Proper disinfection of tonometers is essential to prevent transmission (dilute bleach soak at 1:10 concentration is effective; 70% isopropyl alcohol, 3% hydrogen peroxide, and ethyl alcohol are no longer recommended) 4
- Herpes zoster can cause conjunctivitis and other ocular inflammation; vaccination is strongly recommended for patients ≥50 years or immunocompromised patients ≥19 years 4
Remember that while viral conjunctivitis rarely causes permanent visual loss, its economic impact is considerable due to lost work/school time and healthcare costs 4.