What is the treatment for viral conjunctivitis?

Treatment of Viral Conjunctivitis

Viral conjunctivitis is primarily self-limited and requires supportive care rather than antimicrobial treatment. 1

Diagnosis and Clinical Features

• 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 and hyperemia 3
  • Swelling of lid margin and ciliary injection 2
  • Possible preauricular lymphadenopathy 3
  • May be accompanied by systemic symptoms like fever or respiratory symptoms in cases of pharyngoconjunctival fever 3, 4

Treatment Approach

First-Line Management (Supportive Care)

• No antimicrobial treatment is necessary for uncomplicated viral conjunctivitis as it is self-limited 1, 3
• Supportive measures include:
  • Artificial tears to provide symptomatic relief 1, 5
  • Cold compresses to reduce inflammation and discomfort 1, 5
  • Topical antihistamines for symptomatic relief 1
  • Oral analgesics for pain management 1

When to Consider Topical Corticosteroids

• Topical corticosteroids may be helpful in severe cases with:
  • Marked chemosis or eyelid swelling 1
  • Epithelial sloughing 1
  • Membranous conjunctivitis 1
  • Subepithelial infiltrates causing blurring, photophobia, or decreased vision 1
• Important cautions with corticosteroid use:
  • Close follow-up is mandatory 1
  • May potentially prolong viral shedding (shown in animal models) 1
  • Should be tapered to minimum effective dose 1
  • Consider corticosteroids with poor ocular penetration (fluorometholone, rimexolone, loteprednol) to reduce risk of IOP elevation or cataract formation 1

Treatments to Avoid

• Antibiotics should be avoided as they provide no benefit for viral infections and may cause toxicity 1
• Indiscriminate use of topical corticosteroids should be avoided, especially without proper follow-up 1

Infection Control Measures

• Patient education about the highly contagious nature of viral conjunctivitis is critical 1
• Advise patients to:
  • Minimize contact with others for 10-14 days from symptom onset in the last affected eye 1
  • Practice strict hand hygiene with frequent handwashing 1, 5, 4
  • Avoid sharing towels, pillows, and personal items 1
  • Disinfect commonly touched surfaces 1, 2
• Healthcare setting precautions:
  • Consider abbreviated examination in dedicated exam room 1
  • Properly disinfect equipment (especially tonometer tips) using dilute bleach (1:10 concentration) for 5-10 minutes 1
  • Note that 70% isopropyl alcohol wipes are inadequate for disinfection 1
  • Consider deferring IOP measurement unless absolutely necessary 1

Follow-Up Recommendations

• Patients with severe disease (corneal epithelial ulceration or membranous conjunctivitis) should be re-evaluated within 1 week 1
• Patients on topical corticosteroids require:
  • Regular monitoring of IOP and pupillary dilation 1
  • Gradual tapering once inflammation is controlled 1
• Patients not on corticosteroids should return if symptoms persist beyond 2-3 weeks 1
• Monitor for development of subepithelial infiltrates, which typically appear 1+ weeks after onset 1

When to Refer to an Ophthalmologist

Prompt referral to an ophthalmologist is indicated for patients with:

• Visual loss 1, 5
• Moderate or severe pain 1
• Corneal involvement 1
• Lack of response to therapy 1
• History of HSV eye disease 1
• Immunocompromised status 1, 5

Special Considerations

• Distinguish viral conjunctivitis from herpes simplex virus (HSV) conjunctivitis, which requires specific antiviral treatment 1, 4
• Be aware that viral conjunctivitis can occur during pandemics caused by novel pathogens like SARS-CoV-2 4
• Environmental factors like poor air quality and sanitation may contribute to outbreaks 6