From the Guidelines
Herpes Zoster with ocular involvement, also known as herpes zoster ophthalmicus, requires immediate medical attention to prevent vision loss, and treatment typically includes oral antiviral medication such as valacyclovir (1000mg three times daily for 7-10 days), acyclovir (800mg five times daily for 7-10 days), or famciclovir (500mg three times daily for 7-10 days) 1. The symptoms of herpes zoster ophthalmicus include:
- Unilateral bulbar conjunctival injection
- Watery discharge
- Mild follicular reaction of conjunctiva
- Palpable preauricular node
- Vesicular dermatomal rash or ulceration of eyelids
- Pleomorphic or nonexcavated pseudodendritic epithelial keratitis of cornea These symptoms can lead to complications such as necrosis and scarring from vesicles on the eyelid margins, conjunctiva, and in the corneal stroma, as well as conjunctival scarring from secondary infection, which can lead to cicatricial ectropion 1.
Treatment Options
The treatment options for herpes zoster ophthalmicus include:
- Oral antiviral medication: valacyclovir, acyclovir, or famciclovir
- Pain management: acetaminophen, NSAIDs, or in severe cases, gabapentin or pregabalin
- Topical steroids: may be prescribed by an ophthalmologist, but should not be used without specialist guidance
- Cool compresses: to reduce discomfort and prevent touching or rubbing the eye
- Artificial tears: to reduce dryness and promote eye health
- Sunglasses: to reduce light sensitivity It is essential to seek emergency ophthalmology care within 24 hours of symptom onset to prevent vision loss and minimize the risk of complications 1.
Important Considerations
Individuals over 50 and those with compromised immune systems are at higher risk for complications from herpes zoster ophthalmicus 1. Immunocompromised patients may require more aggressive treatment, and caution is advised in patients with impaired renal clearance 1. Late sequelae of herpes zoster ophthalmicus can include dry eye and corneal anesthesia with neurotrophic keratitis, emphasizing the importance of prompt and effective treatment 1.
From the FDA Drug Label
The efficacy and safety of famciclovir tablets have not been established for: • Patients with ophthalmic zoster
The FDA drug label does not answer the question.
From the Research
Symptoms of Herpes Zoster with Ocular Involvement
- Burning pain typically precedes the rash by several days and can persist for several months after the rash resolves 2
- Ocular involvement can lead to rare but serious complications, including anterior uveitis and acute retinal necrosis 3
- Associated sensory symptoms can range from paresthesia to severe pain, severely affecting the quality of life 3
- Eye involvement can result in prolonged or permanent pain, facial scarring, and loss of vision 4
Treatment Options for Herpes Zoster with Ocular Involvement
- Systemic antiviral treatment, such as orally administered acyclovir, famciclovir, and valacyclovir, is the mainstay of treatment 2, 3, 5
- Addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 2
- Topical and injectable corticosteroids have yet to be proven effective for the treatment of acute pain or prevention of complications 6
- Intrathecal corticosteroid administration may provide a benefit for intractable postherpetic neuralgia, but is a last-line option due to risks of serious complications 6
- Patients with postherpetic neuralgia may require narcotics for adequate pain control, and tricyclic antidepressants or anticonvulsants may help control neuropathic pain 2
- Capsaicin, lidocaine patches, and nerve blocks can also be used in selected patients 2