What is the treatment for viral conjunctivitis?

Treatment of Viral Conjunctivitis

Viral conjunctivitis requires supportive care only—artificial tears, cold compresses, and patient education about contagion are the mainstays of treatment, with antibiotics providing no benefit and potentially causing harm. 1

Primary Supportive Management

The treatment approach is entirely symptomatic since viral conjunctivitis is self-limited in most cases:

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

The majority of cases resolve spontaneously within 1-2 weeks without intervention 3, 4.

Infection Control Measures

Given that adenovirus can survive for weeks on surfaces and is highly contagious 1:

• Patients must minimize contact with others for 10-14 days from symptom onset in the last affected eye 1
• Strict handwashing and personal hygiene are essential to prevent transmission 2, 5
• Disinfect exposed surfaces with sodium hypochlorite 1
• In clinical settings, consider abbreviated exams in dedicated rooms with limited physical interaction 1

Management of Severe Adenoviral Keratoconjunctivitis

For severe cases with significant corneal involvement:

• 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 systemic side effects 1
• Taper slowly to the minimum effective dose 1
• Important caveat: Animal models suggest corticosteroids may prolong viral shedding 1

Management of Specific 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

Special Viral Types Requiring Different Treatment

HSV conjunctivitis:

• Use ganciclovir 0.15% gel, trifluridine 1% solution, or oral antivirals 1, 6
• Avoid corticosteroids as they can cause recurrence with scarring and permanent vision loss 1, 6

VZV conjunctivitis:

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

Molluscum contagiosum-related conjunctivitis:

• Treat the causative lesions through incision and curettage, excision, or cryotherapy 1

Follow-up Protocol

• 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
• Follow-up visits should include interval history, visual acuity measurement, and slit-lamp biomicroscopy 1

Common Pitfalls to Avoid

• Never prescribe antibiotics for viral conjunctivitis—they are ineffective and may cause adverse effects 1, 3
• Never use corticosteroid-antibiotic combinations unless the conjunctivitis is proven to be nonherpetic 6
• Ensure accurate diagnosis, as the clinical accuracy rate for diagnosing viral conjunctivitis is less than 50% 4
• Consider rapid diagnostic tests to decrease unnecessary antibiotic use 4