From the Guidelines
The treatment for Herpes Simplex Virus (HSV) keratitis infection is typically with antiviral medications, such as topical ganciclovir 0.15% gel or trifluridine 1% solution, and oral antivirals like acyclovir, valacyclovir, or famciclovir 1.
Treatment Options
- Topical antivirals: ganciclovir 0.15% gel used three to five times per day, or trifluridine 1% solution five to eight times per day, with ganciclovir being less toxic to the ocular surface 1.
- Oral antivirals: acyclovir (200 to 400 mg five times a day), valacyclovir (500 mg two or three times a day), or famciclovir (250 mg twice a day) 1.
Important Considerations
- Avoid topical corticosteroids as they can potentiate HSV infection, except in cases of secondary HSV stromal keratitis where they may be used in conjunction with oral antiviral therapy 1.
- Follow-up visits should be conducted within 1 week of treatment to monitor the patient's condition and adjust treatment as needed 1.
- Lower doses of oral antivirals may be considered for long-term prophylaxis against recurrent HSV keratitis 1.
From the Research
Treatment Options for Herpes Simplex Virus (HSV) Keratitis Infection
- The management of HSV keratitis involves treating acute episodes and implementing long-term strategies to prevent recurrences and repair corneal nerve endings via neurotization 2.
- Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis 2.
- Current antiviral therapies target viral replication to decrease disease duration, severity, and recurrence 3.
- Therapies directed towards viral entry into cells, protein synthesis, inflammatory cytokines, and vascular endothelial growth factor pathways in animal models represent promising new approaches to the treatment of recurrent HSV keratitis 3.
- The current standard of care for HSV stromal keratitis includes topical corticosteroids and antivirals, but high-quality clinical trials investigating therapies beyond corticosteroids and antivirals are lacking 4.
- Immune regulatory drugs, such as cyclosporine A, present attractive alternatives to managing HSV stromal keratitis, given the immune-mediated pathogenesis of stromal disease 4.
- Inhibiting viral reactivation in the latently infected ganglia through therapeutic vaccination will likely be the most efficient avenue to reduce recurrent HSV ocular disease 4.
- Evidence-based treatment options for HSV epithelial and stromal keratitis include the use of topical trifluridine, topical or oral acyclovir, and topical interferon 5.
- Topical corticosteroids given together with a prophylactic antiviral can shorten the duration of active HSV stromal keratitis, and long-term suppressive oral acyclovir therapy can reduce the incidence of recurrent HSV keratitis 5.
- Trifluridine eye drop, acyclovir ointment, ganciclovir gel, and oral acyclovir are still the main therapeutic agents for HSV epithelial keratitis, and cryopreserved amniotic membrane has been recently used as an adjuvant treatment 6.
- Resistance to acyclovir has become a concerning issue, and new antivirals are under development 6.
- HSV vaccine can be revolutionary in reducing HSV keratitis 6.