What are the treatment options and precautions for a young adult diagnosed with viral conjunctivitis?

Viral Conjunctivitis: Treatment and Precautions for Young Adults

For a young adult with viral conjunctivitis, provide supportive care only with artificial tears, cold compresses, and topical antihistamines—avoid antibiotics entirely, ensure strict hand hygiene, and refer immediately if vision loss, severe pain, or corneal involvement develops. 1

Treatment Approach

Primary Management: Supportive Care Only

• No proven effective antiviral treatment exists for adenoviral conjunctivitis, which causes approximately 80% of viral conjunctivitis cases 1, 2
• Artificial tears (preferably preservative-free and refrigerated) 4 times daily help dilute viral particles and inflammatory mediators while providing symptomatic relief 1
• Cold compresses reduce inflammation and provide comfort 1, 3
• Topical antihistamines (second-generation) alleviate itching and discomfort, though no standardized dosing exists in guidelines 1

Critical: What NOT to Do

• Never use topical antibiotics—they provide no benefit for viral disease, contribute to antibiotic resistance, and can cause toxicity 1, 3
• Avoid topical corticosteroids unless managing severe complications (marked chemosis, lid swelling, epithelial sloughing, or membranous conjunctivitis), as they prolong adenoviral infections 1, 4
• If corticosteroids become necessary for severe cases, close ophthalmologic monitoring is mandatory 1

Exception: Herpes Simplex Virus (HSV) Conjunctivitis

• If HSV is suspected (look for vesicular rash on eyelids/nose, dendritic corneal lesions, or history of HSV eye disease), treatment changes completely 1, 3
• Use topical ganciclovir 0.15% gel OR topical trifluridine 1% solution 1
• Oral antivirals (acyclovir, valacyclovir, or famciclovir) are also effective 1, 5
• Critical pitfall: Never use topical corticosteroids in HSV conjunctivitis without antiviral coverage—they potentiate infection and worsen outcomes 1, 4

Infection Control Precautions

Mandatory Hygiene Measures

• Strict handwashing with soap and water is the single most important measure to prevent transmission 1, 4, 6
• Avoid close contact for 7-14 days from symptom onset 1
• Do not share towels, pillows, or cosmetics 4
• Discard multiple-dose eyedrop containers to avoid cross-contamination 1
• Disinfect surfaces with EPA-registered hospital disinfectant or 1:10 dilution of household bleach 4

Contagion Period

• Viral conjunctivitis spreads easily and remains highly contagious throughout the symptomatic period 6, 2
• Patients should avoid work/school during peak symptoms if possible to limit transmission 3

Red Flags Requiring Immediate Ophthalmology Referral

Urgent Referral Indicators

• Visual loss or decreased vision 1, 4, 3
• Moderate to severe pain (suggests keratitis, uveitis, or acute angle-closure glaucoma) 1, 4
• Corneal involvement (infiltrate, ulcer, opacity, or positive fluorescein staining) 1, 4
• Severe purulent discharge (consider gonococcal infection requiring systemic antibiotics) 1, 7
• Conjunctival scarring 1, 4
• Membranous or pseudomembranous conjunctivitis 4
• History of HSV eye disease (high recurrence risk) 1, 4
• Immunocompromised state 1, 4, 3
• Lack of response to therapy after 3-4 days 1, 7
• Recent ocular surgery 3

Expected Clinical Course

Natural History

• Most viral conjunctivitis is self-limiting and resolves without residual symptoms 6
• Symptoms typically improve within 1-2 weeks without specific treatment 3
• Preauricular lymphadenopathy is common and helps distinguish viral from bacterial causes 4, 3
• May have concurrent upper respiratory infection symptoms 4, 2

Follow-Up Recommendations

• Return for evaluation if no improvement after 3-4 days, or if any red flag symptoms develop 7, 4
• Consider alternative diagnoses (bacterial, allergic, or atypical infections) if symptoms worsen or persist beyond expected timeframe 7

Common Clinical Pitfalls

• Prescribing unnecessary antibiotics: Viral conjunctivitis will not respond to antibacterial agents and antibiotics cause toxicity 1, 4
• Missing HSV conjunctivitis: Failure to recognize HSV (especially with corticosteroid use) can lead to corneal perforation and permanent vision loss 1, 8
• Delayed referral for corneal involvement: Affection of corneal structures can result in permanent visual impairment if not treated promptly 6
• Using trifluridine beyond 2 weeks: Prolonged use causes epithelial toxicity 1