Management of Viral Conjunctivitis in Babies
Viral conjunctivitis in babies requires supportive care only—no antiviral treatment is indicated for the most common cause (adenovirus), and topical antibiotics should be avoided as they provide no benefit and risk adverse effects. 1, 2
Primary Treatment Approach
Supportive care is the cornerstone of management:
- Preservative-free artificial tears applied 4 times daily to dilute viral particles and inflammatory mediators, providing symptomatic relief 2
- Cold compresses for comfort and to reduce inflammation 1, 2
- Topical antihistamines (second-generation) may be used to relieve itching and discomfort, though no specific dosing is standardized in guidelines 2
Critical: Avoid topical antibiotics as viral conjunctivitis will not respond to antibacterial agents, and antibiotics can induce toxicity and promote resistance 2
Infection Control Measures
Strict hand hygiene with soap and water is mandatory to prevent transmission to others or the unaffected eye 3, 2
Additional measures include:
- Avoiding sharing towels or close contact during the contagious period (7-14 days from symptom onset) 3, 2
- Discarding multiple-dose eyedrop containers to avoid cross-contamination 2
Special Considerations for Specific Viral Pathogens
Herpes Simplex Virus (HSV) Conjunctivitis
Neonates with suspected HSV conjunctivitis require immediate pediatric consultation because systemic HSV infection is life-threatening 1, 2
Treatment options when HSV is confirmed or highly suspected:
- Topical ganciclovir 0.15% gel three to five times daily (less toxic to ocular surface) 1, 2
- Topical trifluridine 1% solution five to eight times daily (causes epithelial toxicity if used >2 weeks) 1, 2
- Oral antivirals should be added: acyclovir 200-400 mg five times daily, valacyclovir 500 mg two to three times daily, or famciclovir 250 mg twice daily 1
Absolutely avoid topical corticosteroids in HSV conjunctivitis as they potentiate viral replication and worsen infection 1, 2
Varicella Zoster Virus (VZV) Conjunctivitis
Children with chickenpox-associated conjunctivitis may require topical antibiotics to prevent secondary bacterial infection, as vesicles undergo necrosis before healing 1, 2
- Topical antivirals alone are not helpful for VZV conjunctivitis 1, 2
- Severe or recalcitrant cases may benefit from oral antivirals: acyclovir 800 mg five times daily for 7 days, valacyclovir 1000 mg every 8 hours for 7 days, or famciclovir 500 mg three times daily for 7 days 1
When to Refer to Ophthalmology
Immediate ophthalmology referral is indicated for:
- Visual loss 3, 2
- Moderate to severe pain 3, 2
- Corneal involvement (infiltrate, ulcer, or opacity) 3, 2
- History of HSV eye disease 2
- Immunocompromised state 3, 2
- Conjunctival scarring 3
Follow-Up Recommendations
Return for evaluation if no improvement after 3-4 days of treatment to consider alternative diagnoses or complications 3
For HSV conjunctivitis, follow-up within 1 week should include interval history, visual acuity measurement, and slit-lamp biomicroscopy 1
Critical Pitfalls to Avoid
Do not prescribe topical corticosteroids for adenoviral conjunctivitis unless there is severe disease with marked chemosis, lid swelling, epithelial sloughing, or membranous conjunctivitis—and only with close ophthalmology monitoring for elevated intraocular pressure and cataract formation 1, 2
Never use topical corticosteroids in HSV conjunctivitis without concurrent antiviral coverage, as steroids potentiate HSV infection 1, 2
Do not miss gonococcal or chlamydial conjunctivitis, which present with severe purulent discharge and require systemic antibiotics plus evaluation for sexual abuse in children 3, 2