From the Guidelines
Shingles near the eyes should be treated 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, to prevent potential vision complications and reduce the risk of morbidity and mortality. When treating Herpes Zoster near the eyes, it is essential to consider the potential for secondary infection and the risk of severe conjunctival scarring, which can lead to cicatricial ectropion 1. Some key points to consider when treating this condition include:
- The use of topical antibiotics to prevent secondary infection, as the vesicles will undergo necrosis before healing 1
- The potential for dendritic or stromal keratitis, pseudodendrites, keratitis, corneal scarring, corneal vascularization, iritis/uveitis, sectoral iris atrophy, and secondary glaucoma 1
- The importance of evaluating the patient for corneal involvement, which may require additional treatments like antiviral eye drops or corticosteroids
- The potential for late sequelae, including dry eye and corneal anesthesia with neurotrophic keratitis, which may require prolonged treatment and/or long-term prophylaxis 1
- The need for caution in patients with impaired renal clearance, as well as the potential for chronic disease, which may require prolonged treatment with adjustment of the dose according to the clinical response 1. In terms of specific treatment, the dose and duration of oral antivirals may vary depending on the patient's condition, with immunocompromised patients potentially requiring more aggressive treatment 1. Overall, the goal of treatment is to reduce the risk of morbidity and mortality, improve quality of life, and prevent potential vision complications associated with Herpes Zoster near the eyes.
From the FDA Drug Label
The efficacy of VALTREX when initiated more than 72 hours after the onset of rash and the efficacy and safety of VALTREX for treatment of disseminated herpes zoster have not been established. VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults.
The treatment for Herpes Zoster (Shingles) is valacyclovir (PO), however, the FDA label does not provide information on the treatment for Herpes Zoster near the eyes specifically.
- Indication: Valacyclovir is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults.
- Limitation: The efficacy and safety of valacyclovir for treatment of disseminated herpes zoster have not been established 2.
From the Research
Treatment for Herpes Zoster near the Eyes
- The treatment for Herpes Zoster (shingles) near the eyes typically involves antiviral medications, such as acyclovir, famciclovir, and valacyclovir, which are most effective when started within 72 hours after the onset of the rash 3, 4, 5.
- Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist 3.
- In immunocompromised patients, prompt antiviral therapy is crucial to reduce the incidence of cutaneous and visceral dissemination, and intravenous aciclovir therapy may be reserved for those with disseminated varicella zoster virus infection or ophthalmic involvement 6.
- For postherpetic neuralgia, a complication of herpes zoster, treatment options include antivirals, topical analgesics, opioid analgesics, tricyclic antidepressants, and gabapentin, often requiring a combination of treatment modalities for adequate pain relief 7, 5.
Antiviral Medications
- Valacyclovir 1.5 g twice daily has been shown to be safe and effective for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age 4.
- Acyclovir, famciclovir, and valacyclovir have been shown to reduce the duration of the herpetic rash and zoster-associated pain when used within the first 72 hours of the onset of the rash 3, 4, 5.