What topical antihistamines can be used to treat viral conjunctivitis?

Topical Antihistamines for Viral Conjunctivitis

Topical antihistamines are not specifically indicated for viral conjunctivitis treatment, but may be used symptomatically to relieve discomfort while the condition resolves naturally. 1

Understanding Viral Conjunctivitis

Viral conjunctivitis is the most common form of infectious conjunctivitis and is typically self-limited without requiring specific treatment. The management focuses on supportive care while the infection runs its course.

• Viral conjunctivitis is highly contagious and can survive for many weeks on surfaces, often causing epidemic keratoconjunctivitis (EKC) 2
• There is no proven effective treatment for eradication of adenoviral infection 2
• Most cases resolve spontaneously within 1-2 weeks 1

Symptomatic Treatment Options

While topical antihistamines aren't directly treating the viral infection, they may help manage symptoms:

• Artificial tears, topical antihistamines, cold compresses, and oral analgesics may be used to mitigate symptoms 2
• Supportive care options include artificial tears, cold compresses, and antihistamine eye drops 3

Specific Topical Antihistamine Options

The following topical antihistamines may provide symptomatic relief:

• Pure antihistamines:

  • Emedastine (Emadine)
  • Levocabastine (Livostin) 2

• Combination antihistamine/vasoconstrictor preparations:

  • Antazoline (Vasocon-A)
  • Pheniramine (Visine-A, Naphcon-A, Opcon-A, Nafazair-A) 2

• Dual-action agents (antihistamine and mast cell stabilizer):

  • Azelastine (Optivar) 4
  • Epinastine (Elestat)
  • Ketotifen (Alaway, Zaditor)
  • Olopatadine (Pataday, Patanol) 2

Important Considerations

Cautions

• Antibiotics should be avoided in viral conjunctivitis due to potential adverse effects without benefit 2
• Topical corticosteroids should be used with caution as they may prolong viral shedding and are contraindicated in HSV conjunctivitis 2
• Vasoconstrictors should be used for no more than 10 days to avoid rebound hyperemia or conjunctivitis medicamentosa 2

Patient Education

• Strict personal hygiene including frequent handwashing is essential to decrease transmission risk 3
• Patients should minimize contact with others for 10-14 days from symptom onset 2
• Patients should be instructed to return for follow-up if symptoms persist beyond 2-3 weeks 2

Follow-up Care

• Monitor for development of corneal subepithelial infiltrates, which typically occur 1+ weeks after onset 2
• Patients with severe disease who have corneal epithelial ulceration or membranous conjunctivitis should be re-evaluated within 1 week 2
• If symptoms continue beyond 2-3 weeks, follow-up should include interval history, visual acuity measurement, and slit-lamp biomicroscopy 2

Special Considerations for Different Viral Causes

Herpes Simplex Virus (HSV) Conjunctivitis

• HSV conjunctivitis requires specific antiviral treatment rather than antihistamines
• Treatment options include ganciclovir 0.15% gel or trifluridine 1% solution 2
• Topical corticosteroids are contraindicated as they potentiate HSV infection 2

Adenoviral Conjunctivitis

• Most common viral cause of conjunctivitis
• Primarily managed with supportive care including artificial tears and cold compresses 2
• In severe cases with marked chemosis, lid swelling, or membranous conjunctivitis, topical corticosteroids may be considered under close supervision 2