From the Guidelines
Herpes simplex virus (HSV) eye infections should be treated with antiviral medications, such as oral acyclovir (200 to 400 mg five times a day) or valacyclovir (500 mg two or three times a day), and topical antiviral eye drops like ganciclovir 0.15% gel used three to five times per day, as soon as possible to prevent complications. When treating HSV eye infections, it is essential to consider the potential for corneal involvement and the need for prompt treatment to prevent long-term damage 1. Some key points to consider when treating HSV eye infections include:
- Oral antivirals, such as acyclovir, valacyclovir, or famciclovir, can be effective in treating HSV conjunctivitis 1
- Topical antiviral eye drops, such as ganciclovir or trifluridine, can be used to treat HSV conjunctivitis, but trifluridine can cause epithelial toxicity if used for more than 2 weeks 1
- Topical corticosteroids should be avoided, as they can potentiate HSV epithelial infections 1
- Patients should have a follow-up visit within 1 week of treatment to monitor their condition and adjust treatment as needed 1
- Neonates with HSV eye infections require prompt consultation with a pediatrician or primary care physician, as systemic HSV infection can be life-threatening 1.
From the FDA Drug Label
ZIRGAN ®(ganciclovir ophthalmic gel) 0.15% is indicated for the treatment of acute herpetic keratitis (dendritic ulcers). ZIRGAN is a topical ophthalmic antiviral that is indicated for the treatment of acute herpetic keratitis (dendritic ulcers).
Ganciclovir ophthalmic gel is indicated for the treatment of acute herpetic keratitis (dendritic ulcers), which is a type of HSV eye infection.
- The drug is used to treat dendritic ulcers, a common manifestation of herpetic keratitis.
- Ganciclovir has been shown to be effective in achieving clinical resolution of dendritic ulcers in patients with herpetic keratitis 2.
From the Research
Hsv Eye Infection Treatment
- The treatment of herpes simplex virus (HSV) eye infections includes the use of antiviral agents such as idoxuridine, trifluridine, vidarabine, and acyclovir 3.
- Trifluridine eye drop, acyclovir (ACV) ointment, ganciclovir gel, and oral ACV are still the main therapeutic agents for the management of HSV epithelial keratitis 4.
- A study comparing the effectiveness of antiviral agents found that trifluridine, acyclovir, and brivudine were more effective than idoxuridine, and trifluridine and acyclovir were more effective than vidarabine 5.
Antiviral Agents
- Acyclovir is the gold standard in the treatment of herpes virus infections, and its analogues, such as esters, may gradually replace it in selected applications due to their higher bioavailability and safety 6.
- Ganciclovir and trifluridine combination therapy may be an effective strategy to prevent the development of drug resistance in HSV-1 infections 7.
- The combination of antiviral agents, such as acyclovir and trifluridine, or ganciclovir and trifluridine, can prevent the emergence of drug-resistant HSV-1 strains 7.
Resistance to Antiviral Agents
- Resistance to acyclovir has become a concerning issue in the treatment of HSV epithelial keratitis 4.
- Mutations in the thymidine kinase (TK) and DNA polymerase (DP) genes can confer resistance to nucleoside analogs, including trifluridine, acyclovir, and ganciclovir 7.
- Higher doses of ganciclovir and trifluridine can prevent the development of drug resistance in HSV-1 infections 7.