What is the treatment for viral conjunctivitis?

Treatment of Viral Conjunctivitis

Viral conjunctivitis is predominantly self-limited and requires no antimicrobial treatment; management focuses on symptom relief with artificial tears, topical antihistamines, cold compresses, and oral analgesics while avoiding antibiotics. 1

General Management Approach

• Viral conjunctivitis (most commonly adenoviral) is the most frequent cause of infectious conjunctivitis in adults and is typically self-resolving 2, 3
• Patient education about the highly contagious nature of the virus is essential - adenovirus can survive for weeks on surfaces without proper disinfection 1
• Patients should minimize contact with others for 10-14 days from symptom onset in the last affected eye to prevent transmission 1

Symptomatic Treatment Options

• Artificial tears can provide comfort and help dilute viral particles on the ocular surface 1
• Cold compresses can reduce inflammation and provide symptomatic relief 1, 2
• Topical antihistamines may help alleviate itching and discomfort 1
• Oral analgesics can be used for pain management 1
• Antibiotics should be avoided as they provide no benefit for viral infections and may cause adverse effects 1

Special Considerations for Severe Cases

• For severe adenoviral keratoconjunctivitis with marked chemosis, eyelid swelling, epithelial sloughing, or membranous conjunctivitis, topical corticosteroids may be considered 1
• When using corticosteroids:
  • Close follow-up is mandatory 1
  • Monitor for increased intraocular pressure and cataract formation 1
  • Prefer corticosteroids with poor ocular penetration (fluorometholone) or site-specific options (rimexolone, loteprednol) to minimize side effects 1
  • Taper slowly to the minimum effective dose 1
  • Be aware that animal models suggest corticosteroids may prolong viral shedding 1

Emerging Treatments (Not Yet Established)

• Povidone-iodine has been investigated due to its broad antimicrobial spectrum 1
  • Povidone-iodine 0.4% alone or combined with dexamethasone 0.1% has shown promise in reducing viral titers and shortening clinical course 1
• Off-label topical ganciclovir 0.15% gel has shown potential benefit against specific adenovirus serotypes, but further research is needed 1

Management of Complications

• For membranous conjunctivitis, debridement of membranes may prevent corneal epithelial abrasions or permanent cicatricial changes 1
• For subepithelial infiltrates (occurring 1+ weeks after onset):
  • Mild cases require only observation 1
  • For cases with blurring, photophobia, and decreased vision, topical corticosteroids at minimum effective dose may be considered 1

Prevention of Transmission

• Strict personal hygiene including frequent handwashing 2, 3
• In clinical settings, consider abbreviated exams in dedicated rooms with limited physical interaction 1
• Disinfect exposed surfaces with appropriate disinfectants (e.g., sodium hypochlorite) 1
• Consider triaging patients with suspected viral conjunctivitis to a dedicated "red-eye room" during epidemics 1

Follow-up Recommendations

• Patients with severe disease (corneal epithelial ulceration or membranous conjunctivitis) should be re-evaluated within 1 week 1
• Patients not treated with corticosteroids should return if symptoms persist beyond 2-3 weeks 1
• Follow-up visits should include interval history, visual acuity measurement, and slit-lamp biomicroscopy 1

Special Viral Conjunctivitis Types

• For HSV conjunctivitis: consider ganciclovir 0.15% gel (3-5 times daily), trifluridine 1% solution (5-8 times daily), or oral antivirals; avoid corticosteroids 1, 4
• For VZV conjunctivitis: consider oral antivirals for persistent cases; topical antibiotics may prevent secondary infection 1
• For molluscum contagiosum-related conjunctivitis: treat the causative lesions through incision and curettage, excision, or cryotherapy 1