From the Guidelines
Herpes zoster eye involvement should be treated with antiviral therapy, such as acyclovir 20 mg/kg body weight orally per dose (max 800 mg/dose) 4 times daily for 7--10 days or until no new lesions for 48 hrs, as recommended by the CDC and other reputable health organizations 1. The treatment approach for herpes zoster eye involvement involves a combination of antiviral medications and supportive care. Key considerations include:
- Antiviral therapy: Acyclovir is a preferred therapy, with a recommended dosage of 20 mg/kg body weight orally per dose (max 800 mg/dose) 4 times daily for 7--10 days or until no new lesions for 48 hrs 1.
- Involvement of an experienced ophthalmologist: This is strongly recommended for the management of children with varicella zoster virus retinitis, highlighting the importance of specialized care in cases of eye involvement 1.
- Alternative therapies: Famciclovir may be considered, although its use in pediatric patients is limited due to the lack of a pediatric preparation and limited data on dosing in children 1.
- Supportive care: Pain management and reduction of inflammation may be necessary, but should be done under the supervision of an ophthalmologist to avoid worsening the infection. The goal of treatment is to reduce the severity and duration of symptoms, as well as prevent complications such as keratitis, uveitis, and glaucoma, which can lead to permanent vision loss. Early initiation of antiviral therapy, ideally within 72 hours of rash onset, is crucial for maximizing effectiveness.
From the FDA Drug Label
It is not known if famciclovir tablets are safe and effective for: ... shingles in the eye(s) The FDA drug label does not answer the question.
From the Research
Treatment for Herpes Zoster Eye Involvement
The treatment for herpes zoster eye involvement, also known as herpes zoster ophthalmicus, typically involves antiviral medications.
- Antiviral medications such as acyclovir, valacyclovir, and famciclovir are the mainstay of therapy 2, 3, 4, 5.
- These medications are most effective when started within 72 hours after the onset of the rash 2, 3, 4, 5.
- Early treatment can help prevent ocular involvement and reduce the risk of post-herpetic neuralgia 2, 3, 4, 5.
- In some cases, the addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 2.
- Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist 2, 3, 5.
Duration of Treatment
- A study found that a 7-day course of oral acyclovir was sufficient for the treatment of herpes zoster ophthalmicus, and prolonging treatment for more than 7 days may not be necessary 6.
- The study also found that prompt treatment with oral acyclovir reduced the severity of the skin eruption, the incidence and severity of late ocular manifestations, and the intensity of postherpetic neuralgia 6.
Additional Considerations
- Patients with postherpetic neuralgia may require narcotics for adequate pain control, and tricyclic antidepressants or anticonvulsants may help to control neuropathic pain 2.
- Capsaicin, lidocaine patches, and nerve blocks can also be used in selected patients 2.
- Vaccination in adults over 60 has been found to be highly effective in boosting waning immunity, reducing both the burden of herpes zoster disease and the incidence of post-herpetic neuralgia 5.