What is the treatment for viral conjunctivitis?

Treatment of Viral Conjunctivitis

Viral conjunctivitis is primarily managed with supportive care, as most cases are self-limiting. Treatment includes artificial tears, cold compresses, and patient education on preventing transmission. 1

General Management Approach

• Viral conjunctivitis is highly contagious and patients should minimize contact with others for 10-14 days from symptom onset in the last affected eye to prevent transmission 1
• Patient education about proper hygiene is essential, as adenoviruses (which cause 80% of viral conjunctivitis) can survive for weeks on surfaces 1, 2
• Most cases resolve without specific antiviral treatment, as they are self-limiting 3

First-Line Supportive Treatment

• 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 1
• Warm soaks may relieve itching and burning 4

Important Cautions

• Antibiotics should be strictly avoided as they provide no benefit for viral infections and may cause adverse effects 1
• Corticosteroids should generally be avoided in routine cases, as they may:
  • Prolong viral shedding based on animal models 1
  • Mask serious conditions requiring other interventions 4
  • Lead to complications if used injudiciously 4
  • Be dangerous if used in undiagnosed herpes simplex viral conjunctivitis 2

Prevention of Transmission

• Instruct patients to:
  • Avoid touching their eyes 4
  • Wash hands frequently 4, 2
  • Use disposable towels 4
  • Avoid group activities while ocular discharge is present 4
• Healthcare settings should:
  • Consider abbreviated exams in dedicated rooms 1
  • Disinfect exposed surfaces with appropriate disinfectants 1
  • Consider triaging patients with suspected viral conjunctivitis to a dedicated "red-eye room" during epidemics 1

Management of Severe Cases

• For severe adenoviral keratoconjunctivitis, topical corticosteroids may be considered, but only with mandatory close follow-up 1
• When using corticosteroids:
  • Monitor for increased intraocular pressure and cataract formation 1
  • Prefer corticosteroids with poor ocular penetration to minimize side effects 1
  • Taper slowly to the minimum effective dose 1

Special Viral Conjunctivitis Types

• For herpes simplex virus conjunctivitis:
  • Consider ganciclovir 0.15% gel or trifluridine 1% solution 1
  • Trifluridine is preferred if dendrites are observed 5
  • Avoid corticosteroids 1
• For varicella-zoster virus 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

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
• Referral to an ophthalmologist is advisable if:
  • Signs and symptoms persist despite treatment 5
  • Dendrites are observed (possible herpes infection) 5
  • Complications develop 1

Emerging Treatments (Not Yet Established)

• Povidone-iodine has shown potential to reduce viral titers and shorten clinical course 1
• Off-label topical ganciclovir 0.15% gel has shown potential benefit against specific adenovirus serotypes 1
• Cidofovir has been used successfully in some cases of adenoviral conjunctivitis, though toxicity has been reported 6