Treatment of Viral Conjunctivitis

General Management Approach

The American Academy of Ophthalmology recommends supportive care with artificial tears, cold compresses, and patient education about transmission prevention for 10-14 days from symptom onset 1
Supportive care includes artificial tears to provide comfort and help dilute viral particles on the ocular surface 1
Cold compresses reduce inflammation and provide symptomatic relief 1
Topical antihistamines may alleviate itching and discomfort 1
Oral analgesics can be used for pain management 1
It is critical to avoid topical antibiotics as they provide no benefit for viral infections and may cause toxicity or allergic reactions 1

Patients must minimize contact with others for 10-14 days from symptom onset in the last affected eye, as adenovirus can survive for weeks on surfaces 1
Disinfect exposed surfaces with EPA-registered hospital disinfectants or sodium hypochlorite (1:10 dilution of household bleach) 1
In clinical settings, consider abbreviated exams in dedicated rooms with limited physical interaction 1
Defer intraocular pressure measurement during acute conjunctivitis unless absolutely necessary, as tonometer tips can transmit infection 1

For severe cases with significant subepithelial infiltrates causing blurred vision, photophobia, or decreased visual acuity, topical corticosteroids may be considered—but only with mandatory close ophthalmology follow-up 1
Prefer corticosteroids with poor ocular penetration (such as loteprednol) to minimize intraocular pressure elevation and cataract formation 2
Corticosteroids may prolong viral shedding and can worsen HSV infections if misdiagnosed, potentially leading to corneal scarring and vision loss 1

Herpes Simplex Virus (HSV) conjunctivitis requires antiviral treatment, not corticosteroids alone, with topical options including ganciclovir 0.15% gel or trifluridine 1% solution 2, 3
Oral antivirals such as acyclovir, valacyclovir, or famciclovir may be used for HSV conjunctivitis 2
Topical corticosteroids potentiate HSV epithelial infections and must be avoided 2, 3
Varicella Zoster Virus (VZV) conjunctivitis may be treated with oral antivirals such as acyclovir, valacyclovir, or famciclovir 4, 1
Molluscum contagiosum-related conjunctivitis requires physical removal of the causative eyelid lesions, with options including incision and curettage, simple excision, or cryotherapy 2, 1

For membranous conjunctivitis, debridement of membranes may prevent corneal epithelial abrasions or permanent cicatricial changes 1
For subepithelial infiltrates, mild cases require only observation, while cases with blurring, photophobia, and decreased vision may require topical corticosteroids at minimum effective dose 1

Patients with severe disease should be re-evaluated within 1 week 1
Patients not treated with corticosteroids should return if symptoms persist beyond 2-3 weeks 1
Follow-up visits should include interval history, visual acuity measurement, and slit-lamp biomicroscopy 1
HSV patients require follow-up within 1 week of treatment 2

For persistent or recalcitrant acute/subacute Varicella Zoster Virus (VZV) conjunctivitis in immunocompetent patients, the American Academy of Ophthalmology recommends oral antivirals at specific doses, such as 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, with caution in patients with impaired renal clearance when using oral antivirals 5
The American Academy of Ophthalmology suggests that immunocompromised patients with VZV conjunctivitis may need more aggressive treatment 5
For Molluscum Contagiosum-Related Conjunctivitis, physical removal of the causative eyelid lesions is required, with treatment options including incision and curettage, simple excision, excision and cautery, or cryotherapy, and the conjunctivitis may require weeks to resolve after elimination of the lesion 5
In adults with Molluscum Contagiosum-Related Conjunctivitis, large and multiple molluscum lesions with relatively little conjunctival inflammation may indicate an immunocompromised state 5
The American Academy of Ophthalmology recommends adjusting antiviral dosing in patients with renal impairment to avoid toxicity 5