From the Guidelines
Corneal herpes zoster should be treated with oral antiviral medications, such as valacyclovir (1 gram three times daily) or famciclovir (500 mg three times daily), for 7-10 days to reduce the risk of complications and improve outcomes. This recommendation is based on the most recent evidence, which emphasizes the importance of prompt treatment to prevent corneal scarring, decreased vision, and chronic pain 1.
Key Considerations
- Herpes zoster can cause conjunctivitis, keratitis, and ocular inflammation in multiple tissues of the eye, highlighting the need for comprehensive management 1.
- Herpes zoster vaccination is strongly recommended in patients 50 years or older and patients 19 years or older who are immunocompromised to prevent the infection 1.
- Treatment should also include pain management with oral analgesics, such as acetaminophen or NSAIDs, and topical lubricants to manage dry eye symptoms.
- In cases with significant inflammation, topical steroids (prednisolone acetate 1%) may be prescribed under close ophthalmologic supervision.
Management and Prevention
- Patients should be monitored for complications such as secondary bacterial infections, increased intraocular pressure, and postherpetic neuralgia.
- The virus reactivates from latent infection in the trigeminal ganglion, typically affecting older adults or immunocompromised individuals, and can cause significant ocular morbidity if not properly managed.
- Education on proper hygiene and prevention of transmission is crucial, especially in epidemic adenoviral conjunctivitis, as highlighted in the preferred practice pattern for conjunctivitis 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Corneal Herpes Zoster Overview
- Corneal herpes zoster, also known as herpes zoster ophthalmicus (HZO), occurs when the varicella zoster virus (VZV) reactivates in the first division of cranial nerve V 2.
- It is characterized by a painful, unilateral, dermatomal, vesicular rash and can lead to complications such as eye disease, postherpetic neuralgia (PHN), and strokes.
Treatment Options
- Antiviral medications such as acyclovir, valacyclovir, and famciclovir are commonly used to treat herpes zoster, including HZO 3, 4, 5.
- A systematic review and meta-analysis found that valacyclovir and famciclovir were superior to acyclovir in reducing herpes-zoster-associated pain 5.
- The Zoster Eye Disease Study (ZEDS) is a randomized clinical trial designed to determine whether 1 year of suppressive valacyclovir reduces complications in patients with HZO 6.
Prevention
- The zoster vaccine (ZV) is safe and effective in reducing the burden of illness, severity of PHN, and incidence of HZ 2.
- The Centers for Disease Control and Prevention recommend the ZV for persons aged 60 years and above without impaired cellular immunity, and the Food and Drug Administration has approved it for those aged 50 and older 2.