conjunctivitis%20-%20viral
CONJUNCTIVITIS - VIRAL
Viral conjunctivitis is the inflammation of the conjunctiva of viral etiology.
Signs and symptoms include unilateral or bilateral eye redness, foreign body sensation and follicular conjunctival reaction.
It may be caused by adenovirus, herpes simplex or molluscum contagiosum.

Pharmacotherapy

Adenovirus

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

Artificial Tears

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

Vasoconstrictors/Antihistamines

  • Gives symptomatic relief of itchiness, congestion

Corticosteroids

  • Use is controversial, should only be used under the direct supervision of an ophthalmologist
    • Lowest potency & frequency that relieves patient’s symptoms should be given
  • Only used in severe cases of adenoviral keratoconjunctivitis w/ 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 & 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 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 specif c formulations

Herpes simplex virus (HSV)

Antivirals

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

Non-Pharmacological Therapy

Adenovirus 

Cold Compresses

  • Reduce conjunctival congestion & edema
  • Help relieve pain

Lid Hygiene

  • Saline may be used as an eyewash along w/ cotton-tipped applicators or cotton balls to wipe off the discharge
  • Helps relieve symptoms by mechanically removing debris & discharge & 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 & discharge

Herpes Simplex Virus

Cold Compresses

  • Reduce conjunctival congestion & edema
  • Help relieve pain

Lid Hygiene

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