What is the treatment for viral conjunctivitis?

Treatment of Viral Conjunctivitis

Viral conjunctivitis is primarily managed with supportive care, including artificial tears and cold compresses, as it is typically self-limiting and does not respond to antibiotics. 1, 2

Diagnosis and Clinical Features

Viral conjunctivitis can be distinguished from other forms by:

• Watery discharge (rather than purulent/mucopurulent)
• Preauricular lymphadenopathy (often present)
• Bilateral presentation (often starts in one eye, spreads to the other)
• Associated upper respiratory symptoms (frequently)
• Absence of significant pain or vision loss

Treatment Algorithm

First-Line Management (All Patients)

• Supportive care:
  • Artificial tears for lubrication and comfort 2, 3
  • Cold compresses to reduce inflammation and discomfort 2, 3
  • Strict hygiene measures to prevent spread 1

Specific Viral Etiologies

Adenoviral Conjunctivitis (80% of viral cases) 4

• Primary treatment: Supportive care only
• Duration: Usually self-limiting within 1-2 weeks
• Caution: Avoid topical corticosteroids unless specifically indicated for severe inflammatory reactions and only under ophthalmologist supervision 5

Herpes Simplex Virus Conjunctivitis

• Requires antiviral therapy: Acyclovir, trifluridine, or valacyclovir 5
• Immediate referral: If dendritic lesions are present on cornea 2

Herpes Zoster Ophthalmicus

• Treatment: Systemic antiviral therapy
• Prevention: Vaccination strongly recommended for patients ≥50 years or immunocompromised patients ≥19 years 1

Prevention of Transmission

Viral conjunctivitis is highly contagious. Patient education is critical:

• Wash hands frequently
• Use separate towels and pillows
• Avoid close contact with others during contagious period (10-14 days from onset) 1
• Properly disinfect surfaces with dilute bleach solution (1:10) 1, 2
• For healthcare settings: Disinfect tonometers with dilute bleach soak (1:10) 1

When to Refer to Ophthalmology

Immediate referral is indicated for:

• Visual loss
• Moderate to severe pain
• Corneal involvement
• No improvement after 3-4 days
• Suspected herpes simplex virus (dendritic lesions)
• Immunocompromised patients 2, 3

Common Pitfalls to Avoid

1. Inappropriate antibiotic use: Viral conjunctivitis will not respond to antibacterial agents 1
2. Indiscriminate corticosteroid use: Can worsen herpes simplex infection and should be avoided without ophthalmology consultation 1, 5
3. Failure to recognize serious underlying conditions: Chronic/recalcitrant conjunctivitis may indicate underlying malignancy (sebaceous carcinoma, lymphoma) or inflammatory conditions 1
4. Inadequate infection control: Failure to educate patients about proper hygiene measures can lead to outbreaks, especially in schools and workplaces 1, 2

Remember that while most viral conjunctivitis cases are self-limiting, proper supportive care and hygiene measures are essential to manage symptoms and prevent spread to others.