Recommended Eye Drops for Viral Eye Infections
For herpes simplex virus (HSV) conjunctivitis, use topical ganciclovir 0.15% gel 3-5 times daily or trifluridine 1% solution 5-8 times daily, combined with oral antivirals (acyclovir, valacyclovir, or famciclovir) for optimal outcomes. 1
HSV Conjunctivitis Treatment
Topical antiviral options:
- Ganciclovir 0.15% ophthalmic gel: 1 drop 5 times daily (approximately every 3 hours while awake) until corneal ulcer heals, then 1 drop 3 times daily for 7 days 2
- Trifluridine 1% solution: 5-8 times daily 1
Critical distinction: Topical ganciclovir is significantly less toxic to the ocular surface than trifluridine, which inevitably causes epithelial toxicity if used for more than 2 weeks 1. Ganciclovir has selective activity on viral thymidine kinase with lower potential for toxicity to healthy cells 3.
Combination therapy is essential: Oral antivirals alone may not adequately prevent progression of HSV blepharoconjunctivitis, but adding topical antiviral treatment has proven effective 1. The recommended oral regimens are:
- Acyclovir 200-400 mg five times daily
- Valacyclovir 500 mg two or three times daily
- Famciclovir 250 mg twice daily 1
Varicella Zoster Virus (VZV) Conjunctivitis
Topical antivirals alone have NOT been shown to be helpful for VZV conjunctivitis but may be used as additive treatment in unresponsive patients 1. The primary treatment approach differs significantly from HSV:
- Topical antibiotics are recommended to prevent secondary bacterial infection as vesicles undergo necrosis before healing 1
- For persistent or recalcitrant disease, oral antivirals are the mainstay:
- Acyclovir 800 mg five times daily for 7 days
- Valacyclovir 1000 mg every 8 hours for 7 days
- Famciclovir 500 mg three times daily for 7 days 1
Adenoviral Conjunctivitis (Epidemic Keratoconjunctivitis)
No specific antiviral eye drops are definitively recommended for routine use. Adenoviral conjunctivitis is typically self-limited. However:
- Off-label topical ganciclovir 0.15% gel has shown potential benefit against specific adenovirus serotypes in research settings, but further large-scale efficacy studies are needed before definitive recommendations 1
- Research demonstrates ganciclovir has significant inhibitory activity against adenovirus types 3,4,8, 19a, and 37 with 50% effective concentrations ranging 2.64-5.10 μg/mL 4
Supportive care remains standard:
- Artificial tears for symptomatic relief
- Topical corticosteroids at minimum effective dose may be considered for severe subepithelial infiltrates causing blurring, photophobia, and decreased vision 1
CMV Retinitis (Immunocompromised Patients)
For sight-threatening CMV retinitis in HIV/AIDS patients with CD4+ counts <50 cells/µL:
- Ganciclovir intraocular implant plus oral valganciclovir is superior to IV ganciclovir alone for preventing relapse, particularly for immediate sight-threatening lesions adjacent to the optic nerve or fovea 1
- For small peripheral lesions: oral valganciclovir alone may be adequate 1
- Initial intravitreous ganciclovir injection is recommended by some ophthalmologists to deliver high local concentration immediately until implant placement 1
Critical Caveats
Avoid topical corticosteroids in HSV epithelial infections as they potentiate HSV infection and should be strictly avoided 1.
Contact lens wear is contraindicated during any viral conjunctivitis treatment and when signs/symptoms are present 2.
Neonatal HSV requires urgent systemic evaluation as systemic infection is life-threatening 1.
Monitor for complications: Follow-up within 1 week for HSV cases should include visual acuity measurement and slit-lamp biomicroscopy 1. Patients on prolonged topical corticosteroids require periodic IOP monitoring and pupillary dilation to evaluate for glaucoma and cataract 1.