What is the treatment for viral conjunctivitis?

Treatment of Viral Conjunctivitis

Viral conjunctivitis primarily requires supportive care, including artificial tears, cold compresses, and patient education about preventing transmission, while avoiding unnecessary antibiotics. 1

General Management Approach

• Viral conjunctivitis is self-limiting in most cases, with adenovirus being responsible for approximately 80% of cases 2, 3
• 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 the highly contagious nature is essential, as adenovirus can survive for weeks on surfaces without proper disinfection 1
• Strict personal hygiene, including frequent handwashing, is crucial to decrease transmission risk 4

First-Line Symptomatic Treatment

• Artificial tears provide comfort and help dilute viral particles on the ocular surface 1
• Cold compresses can reduce inflammation and provide symptomatic relief 1, 4
• Topical antihistamines may help alleviate itching and discomfort 1
• Oral analgesics can be used for pain management 1
• Antibiotics should be avoided as they provide no benefit for viral infections and may cause adverse effects 1, 5

Management of Severe Cases

• For severe adenoviral keratoconjunctivitis, topical corticosteroids may be considered, but close follow-up is mandatory 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
  • Be aware that corticosteroids may prolong viral shedding 1
  • Never use corticosteroids unless the conjunctivitis is proven to be non-herpetic 6

Special Considerations for Different Viral Types

• For HSV conjunctivitis, consider ganciclovir 0.15% gel, trifluridine 1% solution, or oral antivirals 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

Management of Complications

• For membranous conjunctivitis, debridement of membranes may prevent corneal epithelial abrasions or permanent cicatricial changes 1
• For subepithelial infiltrates:
  • Mild cases require only observation 1
  • Cases with blurring, photophobia, and decreased vision may require topical corticosteroids at minimum effective dose 1

Prevention of Transmission in Clinical Settings

• Consider abbreviated exams in dedicated rooms with limited physical interaction 1
• Disinfect exposed surfaces with appropriate disinfectants, such as sodium hypochlorite 1
• Consider triaging patients with suspected viral conjunctivitis to a dedicated "red-eye room" during epidemics 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:
  • Conjunctivitis in neonates 4
  • Patients with severe pain or decreased vision 4
  • Recent ocular surgery 4
  • Vesicular rash on the eyelids or nose 4
  • History of rheumatologic disease 4
  • Immunocompromised patients 4

Emerging Treatments

• Povidone-iodine has been investigated due to its broad antimicrobial spectrum and may reduce viral titers 1
• Off-label topical ganciclovir 0.15% gel has shown potential benefit against specific adenovirus serotypes, but further research is needed 1