Valacyclovir Duration for HSV Corneal Ulcer
For HSV corneal ulcer (dendritic keratitis), valacyclovir should be administered at 500 mg two to three times daily for 7-10 days. 1
Treatment Regimen
- Standard dosing: Valacyclovir 500 mg orally two to three times daily for 7-10 days is the recommended treatment for HSV corneal ulceration 1
- Alternative oral options include acyclovir 400 mg five times daily or famciclovir 500 mg three times daily for 7 days 2
- Topical therapy can be used concurrently: ganciclovir 0.15% gel three to five times daily or trifluridine 1% solution five to eight times daily 2
Critical Management Points
Topical corticosteroids must be avoided in HSV epithelial infections as they potentiate viral replication and worsen the ulcer 2, 1. However, if stromal keratitis develops, topical steroids may be used but only in conjunction with oral antiviral therapy 2, 1.
Follow-up within one week is essential and should include visual acuity measurement and slit-lamp biomicroscopy to assess healing 1. If the ulcer persists beyond 7-10 days of standard therapy, consider increasing the dose or evaluating for acyclovir resistance 3.
Important Caveats
- Topical trifluridine causes epithelial toxicity if used for more than 2 weeks, whereas topical ganciclovir is less toxic to the ocular surface 2, 1
- Immunocompromised patients may require more aggressive treatment with higher doses and longer duration, with caution in those with impaired renal clearance 2, 1
- Long-term suppressive therapy at lower doses (valacyclovir 500 mg once daily) should be considered for patients with frequent recurrences 1, 4
Treatment Failure Protocol
If no response occurs after 5-7 days of standard therapy, the lesion is unlikely to respond to valacyclovir or other structurally related drugs (acyclovir, famciclovir) 3. In such cases: