From the Guidelines
Herpes zoster ophthalmicus treatment should begin promptly with oral antivirals, such as acyclovir 800 mg five times daily, valacyclovir 1000 mg every 8 hours, or famciclovir 500 mg three times daily for 7 days, as recommended by the most recent guidelines 1. When treating herpes zoster ophthalmicus, it is essential to consider the potential complications, including keratitis, uveitis, and vision loss.
- The treatment should be initiated within 72 hours of rash onset for maximum effectiveness.
- For immunocompetent patients with persistent or recalcitrant acute/subacute disease, oral antivirals may be beneficial at the aforementioned doses 1.
- Patients with chronic disease may require prolonged treatment with adjustment of the dose according to the clinical response, while those with chronic sequelae may need prolonged treatment and/or long-term prophylaxis 1.
- Immunocompromised patients may need to be treated more aggressively, and caution is advised in patients with impaired renal clearance 1.
- Additionally, pain management and prevention of corneal drying are crucial aspects of treatment, which may include topical lubricating eye drops and pain relief medications such as acetaminophen, NSAIDs, or opioids 1.
- In cases with corneal involvement, topical steroids like prednisolone acetate 1% may be prescribed under ophthalmological supervision 1.
- Regular follow-up with an ophthalmologist is necessary to monitor for complications, especially if eye involvement is present.
From the FDA Drug Label
VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults. The FDA drug label does not answer the question about the treatment of Herpes zoster ophthalmicus specifically. However, Herpes zoster treatment is mentioned, and it can be inferred that valacyclovir may be used for the treatment of herpes zoster in immunocompetent adults.
- The efficacy of valacyclovir when initiated more than 72 hours after the onset of rash has not been established.
- Famciclovir is also indicated for the treatment of herpes zoster (shingles) in immunocompetent adults, and treatment should be initiated within 72 hours of first lesion appearance 2 3.
From the Research
Treatment of Herpes Zoster Ophthalmicus
- The treatment of herpes zoster ophthalmicus typically involves the use of systemic antiviral medication, such as valacyclovir or acyclovir, as the standard first-line treatment 4.
- Valacyclovir has been shown to be at least as effective as acyclovir in preventing ocular complications of herpes zoster ophthalmicus, including conjunctivitis, superficial and stromal keratitis, and pain 5.
- The efficacy of valacyclovir for the treatment of herpes zoster has been confirmed and extended by follow-up studies in herpes zoster ophthalmicus, in Japanese patients, and in the wider primary care setting 6.
- Early recognition and timely treatment with antivirals may prevent ocular complications, and vaccination against herpes zoster can prevent the disease and its complications, including herpes zoster ophthalmicus 7.
Comparison of Valacyclovir and Acyclovir
- Valacyclovir and acyclovir have been compared in several studies, with valacyclovir showing similar efficacy to acyclovir in controlling the symptoms of acute herpes zoster 5, 6.
- Valacyclovir has been shown to alleviate zoster-associated pain and postherpetic neuralgia significantly faster than acyclovir 6.
- The dosing schedule of valacyclovir is simpler than that of acyclovir, with valacyclovir typically given three times daily and acyclovir given five times daily 5.
Prevention of Herpes Zoster Ophthalmicus
- Herpes zoster ophthalmicus is preventable by vaccination against herpes zoster, with both the recombinant adjuvanted vaccine (RZV) and live-attenuated vaccine (ZVL) significantly reducing the incidence of herpes zoster and herpes zoster ophthalmicus in older adults 7.
- RZV is more effective than ZVL in preventing herpes zoster and herpes zoster ophthalmicus 7.
- Vaccination is recommended for individuals likely to benefit from an herpes zoster vaccine, despite barriers to vaccination including patient beliefs and factors related to healthcare providers 7.