From the Guidelines
The acute treatment of herpes zoster ophthalmicus (HZO) requires prompt initiation of oral antiviral therapy, ideally within 72 hours of rash onset, with first-line treatment being valacyclovir 1000 mg every 8 hours for 7 days, as recommended by the most recent guidelines 1. The goal of treatment is to reduce morbidity, mortality, and improve quality of life by minimizing the risk of ocular complications and postherpetic neuralgia.
- Oral antivirals such as valacyclovir, famciclovir, or acyclovir are the mainstay of treatment, with valacyclovir offering better bioavailability than acyclovir 1.
- For immunocompetent patients, the recommended dose is 1000 mg every 8 hours for 7 days for valacyclovir, or 800 mg five times daily for 7 days for acyclovir, or 500 mg three times daily for 7 days for famciclovir 1.
- In cases of severe disease or immunocompromised patients, more aggressive treatment may be necessary, including intravenous antiviral therapy 1.
- Topical ophthalmic treatments, such as prednisolone acetate 1% drops for anterior uveitis, cycloplegics, and artificial tears for corneal protection, are crucial for ocular involvement 1.
- Pain management is essential and typically includes acetaminophen, NSAIDs, and sometimes opioids for severe pain.
- Ophthalmology consultation is recommended for all cases of HZO to assess for ocular involvement and guide management 1.
From the FDA Drug Label
Acute Treatment of Herpes Zoster: 800 mg every 4 hours orally, 5 times daily for 7 to 10 days. The acute treatment for Herpes Zoster (HZ) Ophthalmicus is 800 mg of acyclovir every 4 hours, 5 times daily for 7 to 10 days 2.
- Key points:
- Dose: 800 mg
- Frequency: every 4 hours
- Duration: 7 to 10 days
- Administration: orally, 5 times daily
From the Research
Acute Treatment for Herpes Zoster Ophthalmicus
The acute treatment for Herpes Zoster (HZ) Ophthalmicus typically involves the use of systemic antiviral medication. The following points highlight the key aspects of treatment:
- Systemic antiviral therapy is the mainstay of treatment for HZ Ophthalmicus 3
- Both acyclovir and its prodrug valacyclovir are approved for the systemic treatment of herpes zoster 4
- Valacyclovir has an improved bioavailability and steadier plasma concentration compared to acyclovir, but its effectiveness in reducing ocular complications is still unclear 4
- Acyclovir treatment has been shown to reduce the severity of skin eruption, incidence and severity of late ocular manifestations, and intensity of postherpetic neuralgia 5, 6
- A 7-day course of oral acyclovir (800 mg 5 times daily) has been found to be sufficient for the treatment of HZ Ophthalmicus, with no significant differences in outcomes compared to a 14-day course 5
- Valacyclovir given at 1,000 mg three times daily for 7 days has been shown to accelerate the resolution of pain and offer simpler dosing compared to acyclovir 7
- Treatment with oral acyclovir (600 mg, five times a day) for 10 days has been found to reduce the incidence and severity of common complications of HZ Ophthalmicus, including dendritiform keratopathy, stromal keratitis, and uveitis 6