Treatment of Viral Conjunctivitis
For most cases of viral conjunctivitis, supportive care with artificial tears and cold compresses is the primary treatment, as the condition is self-limited and resolves within 5-14 days without specific antiviral therapy. 1
Supportive Care (First-Line for Most Cases)
The American Academy of Ophthalmology recommends the following supportive measures for typical adenoviral conjunctivitis:
- Preservative-free artificial tears applied frequently to lubricate the ocular surface and dilute inflammatory mediators 1, 2
- Cold compresses to reduce inflammation and provide symptomatic relief 1, 2
- Topical antihistamine eye drops for additional symptomatic relief 2
- Oral analgesics (acetaminophen or NSAIDs) for pain management 1
Avoid topical antibiotics unless secondary bacterial infection is suspected, as they can induce toxicity without providing benefit for viral infection 1, 2
When to Consider Topical Corticosteroids
Topical corticosteroids should be avoided in routine cases but may be considered in specific severe presentations 1:
Indications for Corticosteroid Use:
- Severe disease with marked chemosis and lid swelling 1
- Membranous or pseudomembranous conjunctivitis 1
- Corneal subepithelial infiltrates causing blurred vision, photophobia, or decreased visual acuity (typically occurring 1+ weeks after onset) 1
Preferred Corticosteroid Agents:
Use corticosteroids with poor ocular penetration to minimize risk of elevated intraocular pressure and cataract formation 1:
- Fluorometholone
- Rimexolone
- Loteprednol
Critical Monitoring Requirements:
- Measure intraocular pressure and perform pupillary dilation periodically to evaluate for glaucoma and cataract 1
- Taper to minimum effective dose once inflammation is controlled 1
- Never use corticosteroids if HSV infection is suspected, as they potentiate HSV infection and worsen outcomes 1
Specific Antiviral Treatment (For HSV Conjunctivitis Only)
If herpes simplex virus conjunctivitis is suspected or confirmed, specific antiviral therapy is indicated 1:
Topical Options:
- Ganciclovir 0.15% gel 3-5 times daily (less toxic to ocular surface) 1
- Trifluridine 1% solution 5-8 times daily (causes epithelial toxicity if used >2 weeks) 1
Oral Options:
- Acyclovir 200-400 mg five times daily 1
- Valacyclovir 500 mg 2-3 times daily 1
- Famciclovir 250 mg twice daily 1
Note: Oral antivirals alone may not adequately prevent HSV blepharoconjunctivitis progression; adding topical antiviral treatment is more effective 1
Follow-Up Recommendations
- Severe cases with corneal epithelial ulceration or membranous conjunctivitis: re-evaluate within 1 week 1
- Patients not on corticosteroids: return if symptoms persist beyond 2-3 weeks 1
- Patients on corticosteroids: regular monitoring with visual acuity, IOP measurement, and slit-lamp examination 1
Infection Control
Counsel patients on strict hygiene measures to prevent transmission 1:
- Wash hands frequently with soap and water (not just sanitizer) 1
- Use separate towels and pillows 1
- Avoid close contact with others for at least 7-14 days from symptom onset 1
- Healthcare workers and childcare providers should avoid work during contagious period 1
When to Refer to Ophthalmology
Immediate referral is warranted for 2:
- Visual loss or moderate-to-severe pain
- Corneal involvement beyond superficial punctate keratitis
- Lack of response to therapy
- Neonatal conjunctivitis (requires urgent systemic evaluation)
- Vesicular rash on eyelids or nose (suggests HSV/VZV)