Viral Conjunctivitis: Step Ladder Approach to Treatment

Viral Conjunctivitis is Awful!

If a patient truly has viral conjunctivitis, it really takes 2 weeks to go away & it can cause absolute misery along the way.

Here are some notes I’ve made for patients:

1.If initial treatment does not get better after a couple of days or you just want peace of mind, see and eyeMD to get checked under the microscope (Slit Lamp) to see what you really have:

Viral Conjunctivitis (usually very itchy; history of a cold or around someone with “Pink Eye”? We check for a pre-auricular lymph node; Antibiotics do not help viruses) or 

Bacterial Conjunctivitis (profuse yellow or green discharge; treated with antibiotics). If we see Papillae we think, Allergy or Giant Papillary Conjunctivitis (GPC) if a CL wearer; if see Follicles, we think virus. Crusting on lids, notes Blepharitis. Clogged meibomian glands means Meibomian Gland Dysfunction. A dry tear film &/or conjunctival &/or corneal changes, suggests Dry Eye Syndrome.

2. A pink eye can be due to many things. Classically a “Pink Eye” is due to viral conjunctivitis and can be very contagious with severe itchiness. If you do have true Pink Eye, the most natural way to treat it is cold ice packs for itchiness; cold tears in refrigerator helps also. If severe an eyeMD can prescribe steroid drops. If discharge, use warm towel to clear it away. Any Vision change, see eyeMD.

Step Ladder Approach to Treatment of Viral Conjunctivitis: 

Start with #0

                  6. Erythromycin ointment: Your eyeMD may prescribe an   antibiotic ointment even though it is viral to help  
prevent super infection with a bacteria

5. Low dose steroid drop: Steroids can be a eye (& sanity)   saver for patients who are miserable or have 
EKC(Epidemic Keratoconjunctivitis). Steroids can  
prolong viral shedding but can help alleviate pain, 
itchiness, frustration; long term use has risks (ie: high eye 
pressure, cataract)

             4. Over the counter antihistamine/decongestant drops can help  
(especially if in refrigerator) Naphcon-A can work well in some  

  3. Artificial tears: Put Non-preserved tears (which are best but cost  
more; preserved tears can be used but not more than 4x/day because   of preservative) in refrigerator to help with itchy symptoms); (ie,  
Refresh Plus, Refresh, Tears Plus, Oasis); Artificial ointment (ie, 
Lacrilube, Refresh PM) can provide longer relief than drops but can 
cause temporary blurring so use before bedtime.

    2. Use Cold Ice Packs to try to help decrease itchiness.

1. Isolate the eye and all its secretions as it is highly contagious & will contaminate your other eye or someone else’s eyes easily; (Use your own towel, pillow case; if you touch your eye & then the door knob, this item becomes contaminated and can cause another to get the virus). Lid Hygiene: Use Warm Compresses (warm towel or warm water: but do not let it touch non-affected eye with some diluted Baby Shampoo to keep discharge away from eye as needed. Warm heat helps remove debris from eyelids; Cold compresses/water helps decrease itchiness.

0. If you want to be 100% sure,  an AdenoPlus test for diagnosing adenoviral conjunctivitis is available. Once you know it is viral: antibiotics will not help but may be prescribed to prevent bacterial superinfection; treatment consists of palliative care (things than decrease discomfort); it usually takes 2 weeks to resolve fully.

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