An Update on Viral Conjunctivitis Treatment Strategies: A Narrative Literature Review
Abstract
1. Introduction
2. Methods
3. Current Management Approaches
3.1. Supportive Therapies
3.2. Antiseptics
3.3. Corticosteroids
3.4. Antivirals
3.5. Proposed Management Plan
3.5.1. Management at Presentation
3.5.2. Proposed Treatment Regimen and Follow-Up
3.5.3. Management of Complications
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Study Title | Study Design | Patient Population | Interventions | Outcome Measures |
---|---|---|---|---|
Efficacy of povidone-iodine-containing therapies for treatment of adenoviral conjunctivitis: A systematic review and network meta-analysis. [37] | Systematic review and network metanalysis | A total of 5 articles were included, published between 2015 and 2019 | PVP-I | Clinical efficacy of treatment |
Topical Pharmacological interventions versus placebo for epidemic keratoconjunctivitis [19] | Cochrane systematic review | A total of 10 articles were included, published between 1980 and 2021 | Varied | Clinical diagnosis and treatment strategies |
A systematic review of clinical practice guidelines for infectious and non-infectious conjunctivitis [21] | Systematic review | A total of 15 articles were included, published between 2015 and 2019 | Varied | Clinical practice guidelines for conjunctivitis treatment |
Conjunctivitis: A systematic review [11] | Systematic review | A total of 167 articles were included, published between 1964 and 2020 | Varied | Clinical diagnosis and treatment strategies |
Comparison of the safety and efficacy of topical Tacrolimus (0.03%) versus dexamethasone (0.05%) for subepithelial infiltrates after adenoviral conjunctivitis [46] | Double-masked randomized control trial | 90 adults in 2019 | Treatment arm 1: tacrolimus 0.03% Treatment arm 2: dexamethasone 0.05% | Incidence of subepithelial infiltrates |
Safety and tolerability of a one-time, in-office administration of 5% povidone-iodine in the treatment of adenoviral conjunctivitis: The Reducing Adenoviral Patient Infected Days (RAPID) study [26] | Double-masked randomized control trial | 56 adults, mean age of 34, between 2015 and 2018 | Treatment arm 1: PVP-I 5% Control: preservative-free artificial tears | Corneal fluorescein staining, visual acuity, and participant rated overall ocular discomfort |
Comparative study on the efficacy of non-steroidal, steroid and non-use of anti-inflammatory in the treatment of acute epidemic conjunctivitis [42] | Prospective double-masked randomized control study | 37 adults | Treatment arm 1: prednisolone 1%/ciprofloxacin 0.3% Treatment arm 2: sodium diclofenac 0.1%/ciprofloxacin 0.3% Control: ciprofloxacin 0.3%/artificial tears | Clinical signs and symptoms |
A randomized controlled phase 2 trial of povidone-iodine/dexamethasone ophthalmic suspension for acute viral conjunctivitis [41] | Randomized, double-masked, parallel-group, vehicle-controlled study | 132 adults, mean age of 31, between 2013 and 2014 | Treatment arm 1: PVP-1 0.6%/dexamethasone 0.1% Control: vehicle | Clinical resolution of acute viral conjunctivitis in the study eye |
Efficacy of a Single Administration of 5% Povidone-Iodine in the Treatment of Adenoviral Conjunctivitis [20] | Prospective double-masked, pilot, randomized trial | 56 adults, mean age of 39, between 2015 and 2018 | Treatment arm 1: PVP-I 5% Control: artificial tears | Percent reduction from peak viral load; clinical signs and symptoms |
Treatment of adenoviral keratoconjunctivitis with a combination of povidone-iodine 1.0% and dexamethasone 0.1% drops: a clinical prospective controlled randomized study [38] | Prospective, randomized, controlled, double-blinded clinical trial | 68 adults, 78 eyes, mean age of 47 | Treatment arm 1: PVP-I 1.0%/dexamethasone 0.1% Treatment arm 2: dexamethasone 0.1% Control: Hypromellose 0.3% | Rate of improvement in symptoms and signs of adenoviral keratoconjunctivitis in treatment groups |
One-time low concentration betadine eye wash: A novel treatment for epidemic viral conjunctivitis for accelerated recovery [27] | Prospective, double-masked, randomized control study | 1328 adults, mean age of 29, in 2023 | Treatment arm 1: betadine 1%/moxifloxacin 0.5%/artificial tears Control: moxifloxacin 0.5%/artificial tears | Conjunctival signs of inflammation, patient satisfaction level, and symptom reduction |
Corticosteroids Versus Cyclosporine for Subepithelial Infiltrates Secondary to Epidemic Keratoconjunctivitis: A Prospective Randomized Double-Blind Study [44] | Prospective, double-blind randomized control study | 51 adults and 72 eyes, mean age of 36, between 2017 and 2019 | Treatment arm 1: fluorometholone 0.1% Control: cyclosporin 0.5% | SEI reduction and visual acuity improvement |
Dexamethasone/Povidone Eye Drops versus Artificial Tears for Treatment of Presumed Viral Conjunctivitis: A Randomized Clinical Trial [41] | Randomized, masked, and controlled trial | 122 adults, mean age of 35, between 2011 and 2012 | Treatment arm 1: dexamethasone 0.1%/povidone–iodine 0.4% Control: artificial tears | Disease duration, overall discomfort, itching, foreign body sensation, tearing, redness, eyelid swelling, side effects of the eye drops, intraocular pressure, and the incidence of subepithelial corneal infiltrates |
Symptomatic Treatment of Subepithelial Infiltrates after Viral Conjunctivitis: Loteprednol or Dexamethasone? [43] | Unmasked prospective, comparative clinical study | 15 adults, 30 eyes, between 2014 and 2015 | Eye 1: loteprednol Eye 2: dexamethasone 0.1% | SEI reduction and visual acuity improvement |
Povidone iodine in the treatment of adenoviral conjunctivitis in infants [28] | Prospective, unmasked, clinical trial | 35 infants, 35 eyes, mean age of 3 months, in 2012 | Treatment arm 1: PVP-I 2.5%/artificial tears Control: artificial tears | Lid edema, conjunctival chemosis, fragility of conjunctival vasculature, pseudomembrane formation, and corneal involvement were scored clinically |
Comparative study of topical regimen for adenoviral keratoconjunctivitis by 0.1% fluorometholone with and without polyvinyl alcohol iodine [45] | Prospective open-label study | 19 adults, 27 eyes, mean age of 53, between 2017 and 2019 | Treatment arm 1: 1.5% levofloxacin/0.1% fluorometholone Treatment arm 2: diluted PVP-I/0.1% fluorometholone | Acute signs and symptoms, HAdV DNA copy number, and the presence of multiple subepithelial corneal infiltrates |
Effect of diluted povidone iodine in adenoviral keratoconjunctivitis on the rate of subepithelial corneal infiltrates [31] | Retrospective chart review | 211 adults, mean age od 33, between 2013 and 2016 | PVP-I 2% compared to all other medications | Incidence of complications and sequelae from adenoviral conjunctivitis |
The treatment Models for Adenoviral Keratoconjunctivitis in the Childhood Population [29] | Retrospective chart review | 50 children, mean age of 13, between 2016 and 2019 | Treatment arm 1: PVP-I 2.5%/ganciclovir 0.15%/sodium hyaluronate 0.15% Treatment arm 2: PVP-I 2.5%/sodium hyaluronate 0.15% Treatment arm 3: ganciclovir 0.15%/sodium hyaluronate 0.15% | Clinical findings |
The effects of povidone iodine (pH 4.2) on patients with adenoviral conjunctivitis. [30] | Retrospective chart review | 112 adults, between 2011 and 2014 | Treatment arm 1: PVPI-0.5% Control: natural tears | Clinical findings and side effects |
Treatment of epidemic keratoconjunctivitis with 2% povidone-iodine: a pilot study. [32] | Prospective, interventional, uncontrolled study | 61 adults, 2012 | Treatment arm 1: PVP-I 2% | Recovery rate within 1 week, drug tolerability, and sequelae |
A combination povidone-iodine 0.4%/dexamethasone 0.1% ophthalmic suspension in the treatment of adenoviral conjunctivitis. [35] | Prospective, open-label, single-armed, phase II clinical trial in humans | 6 adults, 9 eyes, in 2008 | Treatment arm 1: PVP-I 0.4%/dexamethasone 0.1% | Clinical findings and viral titers |
A randomized placebo-controlled trial of topical steroid in presumed viral conjunctivitis. [40] | Randomized control trial | 88 adults, between 2003 and 2007 | Treatment arm 1: dexamethasone 0.1% Control: Hypromellose 0.3% | Patient comfort and conjunctival hyperemia |
Topical treatment with 1% cyclosporine for subepithelial infiltrates secondary to adenoviral keratoconjunctivitis. [47] | Prospective, uncontrolled trial | 4 adults, 8 eyes, mean age of 45, in 2010 | Treatment arm 1: CsA 0.05% | Best-corrected decimal visual acuity, intraocular pressure, and evaluation of severity of SEIs |
Cyclosporine a 0.05% eye drops for the treatment of subepithelial infiltrates after epidemic keratoconjunctivitis. [48] | Prospective double-blind randomized study | 28 adults, 34 eyes, mean age of 36, in 2020 | Treatment arm 1: 0.05% CsA Treatment arm 2: FML | Clinical findings and SEI prevalence |
Tacrolimus for the treatment of subepithelial infiltrates resistant to topical steroids after adenoviral keratoconjunctivitis. [49] | Prospective, nonrandomized, noncomparative interventional case series | 7 adults, 10 eyes, mean age of 37, between 2009 and 2013 | Treatment arm 1: 0.03% tacrolimus | Age, sex, CDVA, intraocular pressure, duration and intensity of symptoms, biomicroscopy findings, and duration of therapy |
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Shunmugam, M.; Giovannetti, F.; Yeung, S.N.; Iovieno, A. An Update on Viral Conjunctivitis Treatment Strategies: A Narrative Literature Review. Microorganisms 2025, 13, 1712. https://doi.org/10.3390/microorganisms13081712
Shunmugam M, Giovannetti F, Yeung SN, Iovieno A. An Update on Viral Conjunctivitis Treatment Strategies: A Narrative Literature Review. Microorganisms. 2025; 13(8):1712. https://doi.org/10.3390/microorganisms13081712
Chicago/Turabian StyleShunmugam, Maheshver, Francesca Giovannetti, Sonia N. Yeung, and Alfonso Iovieno. 2025. "An Update on Viral Conjunctivitis Treatment Strategies: A Narrative Literature Review" Microorganisms 13, no. 8: 1712. https://doi.org/10.3390/microorganisms13081712
APA StyleShunmugam, M., Giovannetti, F., Yeung, S. N., & Iovieno, A. (2025). An Update on Viral Conjunctivitis Treatment Strategies: A Narrative Literature Review. Microorganisms, 13(8), 1712. https://doi.org/10.3390/microorganisms13081712