Is polyvinyl alcohol (PVA) solution the same as artificial tears and effective for treating viral conjunctivitis?

Polyvinyl Alcohol vs. Artificial Tears for Viral Conjunctivitis

Polyvinyl alcohol (PVA) solution is a type of artificial tear, not a distinct treatment, and while it provides symptomatic relief in viral conjunctivitis, it does not alter the disease course or improve outcomes compared to other artificial tear formulations. 1, 2

Understanding PVA as an Artificial Tear

• PVA is a demulcent agent used in artificial tear formulations to increase viscosity and prolong contact time with the ocular surface 3
• PVA solutions function identically to other artificial tears by providing lubrication and diluting inflammatory mediators on the ocular surface 1
• In historical studies, 5% PVA was used as a control/placebo treatment in viral conjunctivitis trials, demonstrating it has no antiviral properties 4

Role in Viral Conjunctivitis Management

Artificial tears (including PVA formulations) serve only as symptomatic treatment and do not eradicate adenovirus infection. 1

Symptomatic Benefits Only

• Artificial tears may help mitigate symptoms such as foreign body sensation, irritation, and discomfort in viral conjunctivitis 1
• Cold or refrigerated artificial tears can provide additional comfort through their cooling effect 1
• These products dilute inflammatory mediators on the ocular surface but do not shorten disease duration 1, 2

Evidence of Limited Efficacy

• A randomized controlled trial found no statistically significant difference between topical ketorolac and artificial tears for symptom relief in viral conjunctivitis, with both groups showing similar improvement 2
• Another trial comparing dexamethasone/povidone-iodine to artificial tears showed artificial tears alone did not reduce disease duration (11.8 ± 4.9 days) 5
• PVA specifically showed no benefit in preventing subepithelial corneal infiltrates when used as a control in epidemic keratoconjunctivitis studies 4

Recommended Treatment Approach

The majority of viral conjunctivitis cases are self-limited and require no specific antimicrobial treatment. 1

Primary Management Strategy

• Artificial tears (including PVA formulations) for symptomatic relief only 1, 6
• Preservative-free formulations are preferred for frequent use to minimize irritation 1
• Cold compresses and oral analgesics for additional comfort 1
• Patient education about the highly contagious nature and 10-14 day isolation period 1

When to Escalate Treatment

• Topical corticosteroids should be considered for severe cases with marked chemosis, eyelid swelling, epithelial sloughing, or membranous conjunctivitis 1
• Close follow-up is warranted when using corticosteroids due to potential prolonged viral shedding in animal models 1
• Patients with corneal epithelial ulceration or membranous conjunctivitis should be re-evaluated within 1 week 1

Critical Pitfalls to Avoid

• Do not use antibiotics for viral conjunctivitis as they provide no benefit and risk adverse effects 1, 6
• Avoid indiscriminate use of topical corticosteroids as they can potentially prolong adenoviral infections 1
• Do not rely on artificial tears alone for severe disease with corneal involvement 1
• Patients should understand that artificial tears only provide comfort and do not cure the infection 6