Conjunctivitis%20-%20viral Treatment

Adenovirus

• Treatment is symptomatic; there is no effective treatment against the adenovirus

Artificial Tears

• Provides symptomatic relief
• Assist in washing away debris and discharge

Vasoconstrictors/Antihistamines

• Gives symptomatic relief of itchiness and congestion

Corticosteroids

• Use is controversial; should only be used under the direct supervision of an ophthalmologist
  • Lowest potency and frequency that relieves patient’s symptoms should be given
• Only used in severe cases of adenoviral keratoconjunctivitis with marked chemosis or lid swelling, epithelial sloughing, or membranous conjunctivitis
  • When used to reduce inflammatory signs, duration of use should be <7 days
• May also be used cautiously to decrease visually significant subepithelial cornea infiltrates
  • Some authorities feel that steroid use prolongs the course of the infiltrates
  • Tapering is usually required once subepithelial infiltrates have resolved
• Indiscriminate use of corticosteroids can possibly lengthen adenoviral infection and worsen HSV infection
• Patients on corticosteroid therapy should be advised precautions against the spread of the disease for an additional 2 weeks after symptoms resolve
  • Corticosteroid use may enhance viral replication
• Corticosteroids that are less likely to cause an increase in intraocular pressure (IOP) is preferred (eg Rimexolone, Loteprednol)

Antibiotics

• Optional; toxicity can result from indiscriminate use of topical antibiotics
• May be used as prophylaxis against bacterial infection especially if corticosteroids are used
  • Approximately 19% of patients being treated for adenoviral conjunctivitis have positive bacterial cultures
• Various broad spectrum ophthalmic antibiotics are available. Please see the latest MIMS for specific formulations

Herpes Simplex Virus (HSV) and Varicella Zoster Virus (VZV)

Antivirals

• Recommended to reduce the severity and duration of the disease
• May also decrease the chance of corneal involvement

Adenovirus 

Cold Compresses

• Reduce conjunctival congestion and edema
• Help relieve pain

Lid Hygiene

• Saline may be used as an eyewash along with cotton-tipped applicators or cotton balls to wipe off the discharge
• Helps relieve symptoms by mechanically removing debris and discharge and helps to minimize build-up

Debridement of Membrane or Pseudomembrane

• May be performed under topical anesthesia, if the child is cooperative
• Some conjunctival bleeding may occur when peeling true membranes, but this quickly resolves
• Helps improve comfort by mechanically removing debris and discharge

Herpes Simplex Virus and Varicella Zoster Virus (VZV)

Cold Compresses

• Reduce conjunctival congestion and edema
• Help relieve pain

Lid Hygiene

• Saline may be used as an eyewash along with cotton-tipped applicators or cotton balls to wipe off the discharge
• Helps relieve symptoms by mechanically removing debris and discharge and helps to minimize build-up