From the Guidelines
Viral conjunctivitis treatment should be primarily supportive, focusing on symptom management and prevention of infection spread, as most cases resolve on their own within 1-2 weeks. The treatment approach should prioritize reducing inflammation and discomfort, with measures such as cold compresses applied to the eyes for 5-10 minutes several times daily, and artificial tears like Refresh or Systane used 4-6 times daily to lubricate the eyes and wash away irritants 1. For symptom management, over-the-counter pain relievers like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (400mg every 6-8 hours) may help with discomfort.
To prevent spreading the infection, it is crucial to practice strict hand hygiene, avoid touching the eyes, use separate towels and pillowcases, and dispose of eye makeup. Antiviral medications are rarely needed except in cases of herpes simplex virus conjunctivitis, where topical antivirals like trifluridine 1% drops or ganciclovir 0.15% gel may be prescribed, as indicated in the conjunctivitis preferred practice pattern 1. Antibiotics are ineffective against viral infections and should be avoided unless there's a bacterial superinfection.
Key considerations in managing viral conjunctivitis include:
- Avoiding the indiscriminate use of topical antibiotics or corticosteroids, as they can induce toxicity or worsen certain infections 1
- Recognizing that herpes simplex virus conjunctivitis may require specific antiviral treatment, such as ganciclovir 0.15% gel or trifluridine 1% solution, and potentially oral antivirals like acyclovir, valacyclovir, or famciclovir 1
- Ensuring follow-up visits within 1 week of treatment to assess the response to therapy and adjust the treatment plan as necessary
- Educating patients on the highly contagious nature of viral conjunctivitis and the importance of preventive measures to avoid spreading the infection.
From the Research
Treatment Options for Viral Conjunctivitis
- Supportive care options for viral conjunctivitis include artificial tears, cold compresses, and antihistamine eye drops 2
- Treatment with antihistamines and mast cell stabilizers alleviates the symptoms of allergic conjunctivitis, but is not typically used for viral conjunctivitis 3
- Antiviral medications, such as aciclovir, trifluridine, and valaciclovir, are commonly used to treat herpesvirus infections, while cidofovir has been used to treat some cases of adenoviral conjunctivitis 4
- In most patients, the treatment is symptomatically with artificial tears and antibiotic eye drops in cases accompanied by secondary bacterial infections, not prophylactically 5
Importance of Diagnosis and Hygiene
- Early diagnosis of viral conjunctivitis may help to alleviate short-term symptoms and avoid long-term consequences 6
- Strict personal hygiene, including frequent handwashing, is essential to decrease the risk of transmission 2
- Meticulous and consistent hygiene is the most important prophylactic measure to prevent the spread of viral conjunctivitis 5
Specific Considerations
- Corticosteroid eye solution should not be used as a treatment for adenovirus conjunctivitis, as it can worsen the condition, and diagnosis of herpes simplex viral conjunctivitis is crucial for using corticosteroid eye solution as a treatment 6
- Ophthalmology referral is indicated for conjunctivitis in a neonate or patients with severe pain, decreased vision, recent ocular surgery, vesicular rash on the eyelids or nose, history of rheumatologic disease, or immunocompromised state 2