From the Guidelines
The treatment of zoster keratitis should involve prompt initiation of oral antiviral therapy with valacyclovir 1000mg every 8 hours for 7 days, as it has been shown to be beneficial in treating persistent or recalcitrant acute/subacute disease in immunocompetent patients 1. When treating zoster keratitis, it is essential to consider the potential complications, such as secondary bacterial infection, which can lead to severe conjunctival scarring and cicatricial ectropion 1.
- Key considerations in the treatment of zoster keratitis include:
- Oral antiviral therapy with valacyclovir, famciclovir, or acyclovir for 7-10 days
- Topical antiviral drops, such as ganciclovir 0.15% gel, may be added in severe cases
- Topical corticosteroids, like prednisolone acetate 1%, should be used cautiously to control inflammation after the infection is under control
- Cycloplegic agents, such as cyclopentolate 1% or atropine 1%, can help reduce pain and prevent synechiae formation
- Pain management with oral analgesics and consideration of gabapentin or pregabalin for post-herpetic neuralgia
- Frequent use of artificial tears to maintain ocular surface health Treatment should continue until complete resolution of epithelial defects, with corticosteroids tapered slowly to prevent rebound inflammation 1. In immunocompromised patients, more aggressive treatment may be necessary, and caution is advised in patients with impaired renal clearance 1. Late sequelae, such as dry eye and corneal anesthesia with neurotrophic keratitis, should be monitored and managed accordingly 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment of Zoster Keratitis
- The treatment of zoster keratitis typically involves the use of antiviral medications, such as acyclovir, valacyclovir, and famciclovir 2, 3, 4, 5.
- These medications can help reduce the severity and duration of the disease, as well as the risk of complications such as persistent ocular lesions and postherpetic neuralgia 3, 6, 5.
- Topical antiviral medications, such as ganciclovir, may also be used to treat acute zoster keratitis that is unresponsive to oral antiviral therapy 2.
- Herpes zoster vaccinations are also important for the prevention of the disease 2.
Comparison of Antiviral Medications
- Valacyclovir and famciclovir have been shown to be more effective than acyclovir in reducing the risk of pain associated with herpes zoster, including ophthalmicus 6, 5.
- Valacyclovir has a simpler dosing schedule than acyclovir and has been shown to be as effective in preventing ocular complications of herpes zoster ophthalmicus 3.
- The choice of antiviral medication should be based on the individual patient's needs and medical history, as well as the severity of the disease 4.
Management of Ocular Complications
- Ocular complications of herpes zoster ophthalmicus, such as conjunctivitis, superficial and stromal keratitis, and uveitis, can be managed with antiviral medications and other treatments as needed 3, 6.
- Early diagnosis and treatment are important to reduce the risk of permanent vision loss and other complications 2.