What is the treatment for adenovirus conjunctivitis?

Treatment of Adenoviral Conjunctivitis

Adenoviral conjunctivitis is primarily self-limited with no proven effective treatment for eradication of the virus; management focuses on symptomatic relief, preventing complications, and limiting transmission. 1

General Management Approach

• Adenoviral conjunctivitis is highly contagious and patients should minimize contact with others for 10-14 days from symptom onset in the last affected eye 1, 2
• Patient education about virus survival on surfaces for weeks is essential to prevent transmission 1, 3
• In clinical settings, consider abbreviated exams in dedicated rooms with limited physical interaction to prevent spread 1

Symptomatic Treatment Options

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

Management of Severe Cases

• Topical corticosteroids may be beneficial in severe cases with:

  • Marked chemosis or eyelid swelling 1
  • Epithelial sloughing 1
  • Membranous conjunctivitis 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) 1
  • Taper slowly to the minimum effective dose 1, 2
  • Be aware that animal models suggest corticosteroids may prolong viral shedding 1

Management of Complications

• For membranous conjunctivitis, debridement of membranes may prevent corneal epithelial abrasions or permanent cicatricial changes 1
• For subepithelial infiltrates (typically occurring 1+ weeks after onset):
  • Mild cases require only observation 1
  • Cases with blurring, photophobia, and decreased vision may require topical corticosteroids at minimum effective dose 1
  • Regular follow-up with visual acuity measurement, IOP monitoring, and slit-lamp biomicroscopy 1

Emerging Treatments (Not Yet Established)

• Povidone-iodine has been investigated due to its broad antimicrobial spectrum 1
  • Povidone-iodine 0.4% alone or with dexamethasone 0.1% has shown reductions in viral titers and shortened clinical course 1
• Off-label topical ganciclovir 0.15% gel has shown potential benefit against specific adenovirus serotypes, but further research is needed 1, 4
• Benzalkonium chloride at 0.1% concentration has demonstrated antiviral activity against adenovirus in vitro, but ocular toxicity is a concern 5

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
• Patients on prolonged topical corticosteroids require regular monitoring of IOP and pupillary dilation 1

Prevention of Transmission

• Strict hand hygiene and surface disinfection are crucial 3
• Patients should avoid sharing towels, pillows, and cosmetics 2
• Healthcare providers should disinfect equipment between patients 2, 6
• Consider the impact on work/school attendance, especially for those in healthcare, food service, or sales 1

Adenoviral conjunctivitis is typically self-limited with most cases resolving within 2-3 weeks, though subepithelial infiltrates may persist longer and occasionally recur 1, 7.