What is the recommended treatment for a patient diagnosed with Viral Conjunctivitis?

Treatment of Viral Conjunctivitis

Viral conjunctivitis requires no antimicrobial treatment and should be managed with supportive care only, as it is self-limited and antibiotics provide no benefit while risking unnecessary toxicity. 1

Supportive Care Measures

The cornerstone of management involves symptomatic relief through non-pharmacologic and topical interventions:

• Artificial tears provide lubrication and comfort, and can be refrigerated for additional soothing effect 1, 2
• Cold compresses reduce inflammation and provide symptomatic relief 1
• Topical antihistamines may be used for symptomatic relief of associated itching 1
• Patients should be instructed to clean eyelids gently with warm water to remove discharge 1

Critical: Avoid Antibiotics

Antibiotics must be avoided entirely in viral conjunctivitis as they provide no therapeutic benefit and may cause drug toxicity, allergic reactions, and contribute to antimicrobial resistance. 3, 1, 4

This represents a strong recommendation from the American Academy of Ophthalmology, as viral infections will not respond to antibacterial agents regardless of severity 3

When to Consider Topical Corticosteroids

Corticosteroids should be reserved for severe cases only and require close ophthalmology supervision:

• Consider only for: marked chemosis, epithelial sloughing, membranous conjunctivitis, or pseudomembrane formation 3, 1
• Requires: regular monitoring of intraocular pressure and periodic pupillary dilation 1, 4
• Caution: may prolong viral shedding and can worsen herpes simplex virus infections if misdiagnosed 4
• Patients on corticosteroids need ophthalmology follow-up within 1 week 1

Infection Control: Breaking the Chain of Transmission

Patient education is critical to prevent epidemic spread:

• Advise patients to minimize contact with others for 10-14 days from symptom onset 1, 4
• Hand hygiene: wash hands frequently with soap and water 3, 4
• Avoid sharing: towels, pillows, cosmetics, or any personal items 3, 4
• No contact lens wear during active infection 4
• Patients should avoid touching or rubbing their eyes 4

The ophthalmologist plays a critical role in breaking the chain of transmission through proper patient education 3

Healthcare Setting Precautions

• Disinfect tonometers with dilute bleach (sodium hypochlorite) at 1:10 concentration 3
• Note: 70% isopropyl alcohol, 3% hydrogen peroxide, and ethyl alcohol are no longer recommended for tonometer disinfection 3
• Disinfect surfaces with EPA-registered hospital disinfectant according to label directions 3, 4
• Consider abbreviated examination in dedicated exam rooms to limit exposure 1

Follow-Up Recommendations

• Severe cases: re-evaluate within 1 week with interval history, visual acuity measurement, and slit-lamp biomicroscopy 1
• Patients not on corticosteroids: return only if symptoms persist beyond 2-3 weeks 1
• Monitor for: development of subepithelial infiltrates, which can occur weeks after initial infection 1
• Expected course: most cases resolve within 5-14 days without intervention 4

Red Flags Requiring Immediate Ophthalmology Referral

Refer urgently if any of the following are present:

• Visual loss or decreased vision 1, 4
• Moderate or severe pain (viral conjunctivitis should be minimally painful) 1, 4
• Corneal involvement (dendritic lesions, infiltrates, or ulceration) 1, 4
• Lack of response to therapy after 2-3 weeks 1
• History of herpes simplex virus eye disease 1, 4
• Immunocompromised status 1, 4
• Vesicular rash on eyelids or nose (suggests herpes zoster ophthalmicus) 4, 2

Common Pitfalls to Avoid

• Do not prescribe antibiotics reflexively - this is the most common error and provides no benefit while causing potential harm 3, 1
• Do not use combination antibiotic-steroid preparations unless herpes simplex has been definitively ruled out, as steroids can cause corneal perforation in HSV keratitis 5
• Do not underestimate contagiousness - inadequate patient education leads to community spread and workplace/school outbreaks 4
• Do not use topical corticosteroids without ophthalmology involvement - risks include elevated intraocular pressure, cataract formation, and prolonged viral shedding 1, 4