What is the treatment for viral conjunctivitis?

Treatment of Viral Conjunctivitis

The treatment for viral conjunctivitis is primarily supportive care, including artificial tears, cold compresses, and patient education about preventing transmission, as most cases are self-limiting and do not require antibiotics. 1

Diagnosis and Clinical Presentation

• Viral conjunctivitis accounts for approximately 80% of all acute conjunctivitis cases, with adenovirus being the most common causative agent 2
• Clinical features include watery discharge, hyperemia, chemosis, and possible ipsilateral lymphadenopathy 3
• No single sign or symptom accurately differentiates viral from bacterial conjunctivitis, but viral conjunctivitis typically presents with watery discharge rather than mucopurulent discharge 4

Management Approach

First-line Supportive Measures

• Artificial tears provide comfort and help dilute viral particles on the ocular surface 1
• Cold compresses reduce inflammation and provide symptomatic relief 1
• Topical antihistamines may help alleviate itching and discomfort 1
• Oral analgesics can be used for pain management in uncomfortable cases 1

Prevention of Transmission

• Patients should minimize contact with others for 10-14 days from symptom onset in the last affected eye 1
• Strict personal hygiene with frequent handwashing is essential to decrease transmission risk 4
• In clinical settings, consider abbreviated exams in dedicated rooms with limited physical interaction 1
• Disinfect exposed surfaces with appropriate disinfectants, such as sodium hypochlorite 5, 1

Important Cautions

• Antibiotics should be avoided as they provide no benefit for viral infections and may cause adverse effects 1, 6
• Indiscriminate use of topical antibiotics or corticosteroids should be avoided, as antibiotics can induce toxicity and corticosteroids can potentially prolong adenoviral infections 5
• The clinical accuracy in diagnosing viral conjunctivitis is less than 50%, so careful assessment is important 3

Special Considerations for Severe Cases

• For severe adenoviral keratoconjunctivitis with significant corneal involvement, topical corticosteroids may be considered, but only with close ophthalmologic follow-up 1
• When using corticosteroids, monitor for increased intraocular pressure and cataract formation 1
• For membranous conjunctivitis, debridement of membranes may prevent corneal epithelial abrasions 1
• For subepithelial infiltrates causing visual symptoms, topical corticosteroids at minimum effective dose may be necessary 1

Follow-up Recommendations

• Patients with severe disease should be re-evaluated within 1 week 1
• Patients not treated with corticosteroids should return if symptoms persist beyond 2-3 weeks 1
• Ophthalmology referral is indicated for patients with severe pain, decreased vision, recent ocular surgery, vesicular rash on the eyelids or nose, history of rheumatologic disease, or immunocompromised state 4

Special Viral Conjunctivitis Types

• For HSV conjunctivitis, consider ganciclovir 0.15% gel, trifluridine 1% solution, or oral antivirals, and avoid corticosteroids 1
• For VZV conjunctivitis, consider oral antivirals for persistent cases 1
• For molluscum contagiosum-related conjunctivitis, treat the causative lesions through incision and curettage, excision, or cryotherapy 1

Common Pitfalls to Avoid

• Using antibiotics prophylactically in viral conjunctivitis (they are only indicated if there's a secondary bacterial infection) 7
• Initiating corticosteroids without proper diagnosis (can worsen HSV infections) 5
• Failing to educate patients about the highly contagious nature of viral conjunctivitis 1
• Not implementing proper infection control measures in clinical settings 5, 1