Conjunctivitis%20-%20viral Treatment
Pharmacotherapy
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
Non-Pharmacological Therapy
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