What is the treatment for viral conjunctivitis versus other types of conjunctivitis?

Treatment of Viral Conjunctivitis vs Other Types of Conjunctivitis

Viral conjunctivitis requires only supportive care with artificial tears and cold compresses, while bacterial conjunctivitis may benefit from topical antibiotics in moderate-to-severe cases, and allergic conjunctivitis responds to topical antihistamines with mast cell-stabilizing activity. 1

Viral Conjunctivitis Management

Avoid antibiotics entirely for viral conjunctivitis—they provide no benefit and may cause toxicity. 1

Supportive Care Measures

• Artificial tears provide comfort and help dilute viral particles on the ocular surface 2
• Cold compresses reduce inflammation and provide symptomatic relief 2
• Topical antihistamines may alleviate itching and discomfort 2
• Oral analgesics can be used for pain management 2

Patient Education and Infection Control

• Patients must minimize contact with others for 10-14 days from symptom onset in the last affected eye 2
• Emphasize strict hand hygiene with soap and water, as adenovirus can survive for weeks on surfaces 2
• Avoid sharing personal items like towels and pillows 1

When to Consider Corticosteroids (Use with Extreme Caution)

For severe adenoviral keratoconjunctivitis with subepithelial infiltrates causing blurring, photophobia, and decreased vision, topical corticosteroids may be considered, but this requires close ophthalmology follow-up 2. Key precautions include:

• Monitor for increased intraocular pressure and cataract formation 2
• Prefer corticosteroids with poor ocular penetration to minimize side effects 2
• Taper slowly to the minimum effective dose 2
• Never use corticosteroids for HSV conjunctivitis—they worsen the infection 1

Follow-Up Timing

• Patients with severe disease should be re-evaluated within 1 week 2
• Patients not on corticosteroids should return if symptoms persist beyond 2-3 weeks 2

Bacterial Conjunctivitis Management

Clinical Presentation

Bacterial conjunctivitis presents with mucopurulent discharge with matted eyelids and a papillary (not follicular) reaction 1

Treatment Approach

• Mild cases are usually self-limited and may resolve without treatment 1
• Moderate-to-severe cases benefit from a 5-7 day course of broad-spectrum topical antibiotic 1
• No specific topical antibiotic has proven superiority—choose the most convenient or least expensive option 1
• Topical antibiotics decrease duration and allow earlier return to school or work 3

Special Situations Requiring Systemic Treatment

• Gonococcal conjunctivitis requires systemic treatment in addition to topical therapy and can lead to corneal perforation 1
• Chlamydial conjunctivitis requires systemic treatment and evaluation of sexual partners 1
• Contact lens wearers with conjunctivitis should always be treated with antibiotics and referred to evaluate for corneal ulcers 4

Allergic Conjunctivitis Management

First-Line Treatment

Topical antihistamines with mast cell-stabilizing activity are the treatment of choice 1, 5

Environmental Modifications

• Wear sunglasses as a barrier to airborne allergens 1
• Use cold compresses and refrigerated artificial tears 1
• Avoid eye rubbing 6
• Consider hypoallergenic bedding and frequent clothes washing 6

Escalation for Refractory Cases

For symptoms not adequately controlled, a brief 1-2 week course of topical corticosteroids with low side-effect profile can be added 6, 1

Key Distinguishing Features at Presentation

Viral Conjunctivitis

• Watery discharge with follicular reaction on inferior tarsal conjunctiva 1
• Preauricular lymphadenopathy often present 1
• Abrupt onset, often unilateral initially but becomes sequentially bilateral 1
• May have concurrent upper respiratory infection 1

Bacterial Conjunctivitis

• Mucopurulent discharge with matted eyelids on waking 1, 3
• Papillary (not follicular) reaction 1
• Lack of itching and no history of prior conjunctivitis 3

Allergic Conjunctivitis

• Itching is the most consistent and distinguishing feature 1
• Bilateral presentation with watery discharge 1
• Often seasonal or perennial depending on allergen exposure 1
• Absence of preauricular lymphadenopathy and matted eyelids 1

Critical Red Flags Requiring Immediate Ophthalmology Referral

• Visual loss or decreased vision 1
• Moderate or severe pain 1
• Corneal involvement 1
• Conjunctival scarring 2
• History of HSV eye disease 1
• Immunocompromised state 1
• Neonatal conjunctivitis 1
• Vesicular rash on eyelids or nose 5

Common Pitfalls to Avoid

• Never use topical antibiotics indiscriminately for viral conjunctivitis—they cause toxicity without benefit 1
• Never use corticosteroids for HSV conjunctivitis—they worsen the infection 1
• Chronic use of vasoconstrictor agents can cause rebound vasodilation 1
• Contact lens wear should be avoided during any form of infectious conjunctivitis 1
• Inadequate patient education about contagiousness leads to community spread 1