What is the treatment for viral conjunctivitis?

Treatment of Viral Conjunctivitis

The treatment of viral conjunctivitis is primarily supportive, focusing on symptom relief while the infection resolves naturally, with artificial tears, cold compresses, and patient education about preventing transmission being the cornerstones of management. 1

General Management Approach

• Viral conjunctivitis is highly contagious, requiring patients to minimize contact with others for 10-14 days from symptom onset in the last affected eye to prevent transmission 1
• Patient education is essential as adenovirus can survive for weeks on surfaces without proper disinfection 1
• Adenoviruses account for approximately 80% of viral conjunctivitis cases, making prevention of spread crucial 2

First-Line Symptomatic Treatment

• Artificial tears provide comfort and help dilute viral particles on the ocular surface 1
• Cold compresses can effectively reduce inflammation and provide symptomatic relief 1
• Topical antihistamines may help alleviate itching and discomfort associated with the inflammatory response 1
• Oral analgesics can be used for pain management when needed 1

Important Cautions

• Antibiotics should be avoided as they provide no benefit for viral infections and may cause adverse effects 1
• Most cases of viral conjunctivitis are self-limited and require no specific treatment beyond supportive care 3
• Corticosteroids should be used with extreme caution and generally avoided unless prescribed by an ophthalmologist, as they can worsen herpetic infections 4, 1
• Clinical accuracy in diagnosing viral conjunctivitis is less than 50%, highlighting the importance of careful assessment 3

Management of Specific Types of Viral Conjunctivitis

Adenoviral Conjunctivitis

• For severe adenoviral keratoconjunctivitis, topical corticosteroids may be considered, but only with close ophthalmological follow-up 1
• When corticosteroids are used, monitor for increased intraocular pressure and cataract formation 1
• For membranous conjunctivitis, debridement of membranes may prevent corneal epithelial abrasions 1
• For subepithelial infiltrates causing visual symptoms, topical corticosteroids at minimum effective dose may be considered 1

Herpes Simplex Virus (HSV) Conjunctivitis

• Consider ganciclovir 0.15% gel, trifluridine 1% solution, or oral antivirals 1
• Avoid corticosteroids in suspected or confirmed HSV conjunctivitis 1, 4
• If dendrites are seen on examination, trifluridine (Viroptic) is the preferred treatment 4

Varicella Zoster Virus (VZV) Conjunctivitis

• Consider oral antivirals for persistent cases 1
• Topical antibiotics may be used to prevent secondary bacterial infection 1

Emerging Treatments (Not Yet Established)

• Povidone-iodine has shown potential due to its broad antimicrobial spectrum, possibly reducing viral titers and shortening clinical course 1, 5
• Low concentrations (<1.0%) of povidone-iodine are generally well-tolerated, but efficacy appears to be concentration-dependent 5
• Off-label topical ganciclovir 0.15% gel has shown potential benefit against specific adenovirus serotypes, but further research is needed 1, 6
• Cidofovir has been used successfully in some cases of adenoviral conjunctivitis, though toxicity has been reported 6

Prevention of Transmission

• Implement strict hand washing protocols and surface sanitization to control spread 2
• 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
• Referral to an ophthalmologist is advisable if symptoms persist or worsen, as recurrence with scarring and permanent vision loss is possible 4