From the Guidelines
Facial shingles around the eye (herpes zoster ophthalmicus) requires prompt medical treatment 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, as recommended by the most recent and highest quality study 1. The treatment of herpes zoster around the eye should prioritize preventing secondary infections and reducing the risk of vision complications.
- Topical antibiotics may be used to prevent secondary bacterial infections, as the vesicles will undergo necrosis before healing, and severe conjunctival scarring from secondary bacterial infection can lead to cicatricial ectropion 1.
- Topical antivirals alone have not been shown to be helpful in treating VZV conjunctivitis but may be used as additive treatment in unresponsive patients 1.
- Patients with persistent or recalcitrant acute/subacute disease may require oral antivirals, and those with chronic disease may require prolonged treatment with adjustment of the dose according to the clinical response 1.
- An ophthalmologist evaluation is essential, as eye involvement can lead to serious conditions like keratitis or uveitis, potentially requiring additional treatments such as steroid eye drops.
- Pain management typically includes acetaminophen, NSAIDs, or in severe cases, prescription pain medications, and cool compresses can help reduce inflammation, while keeping the affected area clean prevents secondary bacterial infections.
- The older study 1 provides some guidance on treatment options, but its recommendations are less relevant due to the more recent and higher quality evidence provided by 1.
From the Research
Treatment for Herpes Zoster around the Eye
The treatment for Herpes Zoster (shingles) around the eye typically involves antiviral medications, such as:
- Acyclovir
- Valacyclovir
- Famciclovir 2, 3, 4, 5 These medications are most effective when started within 72 hours after the onset of the rash 2, 3, 6, 4, 5.
Ocular Involvement
Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist 2. Valaciclovir and aciclovir have demonstrated similar efficacy for the control of cutaneous lesions and ocular complications in patients with zoster ophthalmicus 3.
Pain Management
Patients with postherpetic neuralgia may require narcotics for adequate pain control 2. Other treatment options for pain management include: