Artificial Tears for Viral Conjunctivitis
For viral conjunctivitis, use preservative-free artificial tears as the primary supportive treatment, applied as frequently as needed to provide symptomatic relief and help dilute viral particles and inflammatory mediators on the ocular surface. 1
Why Preservative-Free Formulations
Preservative-free artificial tears are strongly preferred because viral conjunctivitis often requires frequent application (more than 4 times daily), and preserved formulations can cause additional ocular surface toxicity and irritation with repeated use. 2
Frequent instillation helps mechanically flush viral particles and inflammatory mediators from the ocular surface while providing lubrication and comfort. 1
Application Strategy
Refrigerate the artificial tears before use - the cooling sensation upon instillation provides additional symptomatic relief beyond the lubricating effect alone. 1
Apply as frequently as needed throughout the day, typically every 1-2 hours during waking hours for maximal comfort and viral particle dilution. 1
Continue use until symptoms resolve, typically 5-14 days for most cases of adenoviral conjunctivitis. 1
What Artificial Tears Do NOT Do
Artificial tears do not shorten the duration of viral conjunctivitis or eradicate the virus - they are purely supportive and symptomatic treatment. 1, 3
The evidence comparing artificial tears with antiviral agents shows no proven effective treatment exists for eradicating adenovirus infection. 1
Additional Supportive Measures to Combine with Artificial Tears
Cold compresses applied for several minutes provide additional symptomatic relief and reduce inflammation. 1, 4
Topical antihistamines (such as ketotifen or olopatadine) may be added if significant itching is present, though they do not alter the disease course. 1
Oral analgesics for pain management if needed. 1
Critical Pitfalls to Avoid
Never add topical antibiotics - they provide no benefit for viral infection and can cause additional toxicity and adverse effects. 1
Avoid indiscriminate use of topical corticosteroids - while they reduce symptoms, they may prolong viral shedding in animal models and should only be used in severe cases with marked chemosis, epithelial sloughing, or membranous conjunctivitis under close ophthalmologic follow-up. 1
Do not use preserved artificial tears if frequent application is needed - limit preserved formulations to less than 4 times daily use only. 2
When to Escalate Beyond Artificial Tears
Severe disease with membranous conjunctivitis, marked chemosis, or epithelial sloughing warrants consideration of topical corticosteroids, but requires close ophthalmologic follow-up within 1 week and monitoring for elevated intraocular pressure and cataract formation. 1
Persistent symptoms beyond 2-3 weeks require re-evaluation with slit-lamp biomicroscopy to assess for subepithelial infiltrates or other complications. 1