1. No category

Managing HSV and
HZV Keratitis
Herpes Simplex Keratitis
 Epithelial
keratitis
 Stromal keratitis
Topical Treatment of HSV
Epithelial Keratitis
Ganciclovir
(Zirgan)
0.15% gel
5x/day
 Trifluridine
(Viroptic) 1% drops
5-9 x/day
 Acyclovir
3% ointment 5x/day*
* not available in US
Oral Treatment of HSV
Epithelial Keratitis
 Acyclovir 200-400 mg 5x/day
 Valacyclovir 500-1000 mg 2-3x/day
 Famciclovir 125-250 mg 2x/day
for 5-10 days
+/- minimal wiping debridement
Topical Steroid Therapy in
HSV Keratitis
Disciform
edema
Stromal keratitis
Oral or topical antiviral coverage
Corticosteroids in Ocular HSV
 Enhance
viral proliferation but do not
trigger viral reactivation or shedding
 Concomitant antiviral therapy reduces
occurrence of epithelial keratitis
Suppressive Oral Anti-HSV
Therapy
Acyclovir 200-400mg 2x/day
 Valacyclovir 500 mg 1-2x/day
 Famciclovir 125-250mg 2x/day
HZV Keratitis
 Microdendrites
 Macrodendrites
 Stromal
keratitis
 Neurotrophic keratitis
Treatment of HZV
Macrodendritic Keratitis
 Topical
Vira-A 3% ointment*
 Topical Zirgan 0.15% gel*
 Acyclovir 800mg po 5x/day*
 Valocyclovir 1000mg po 3x/day*
 Famciclovir 500mg po 3x/day*
* ? dosage and duration
Medical Treatment of HZV
Stromal Keratitis
 Topical
 No
steroid
topical or oral antiviral
coverage needed although can be
helpful for treatment of
macrodendritic epithelial keratitis
HSV Neurotrophic Keratitis
HZV Neurotrophic Keratitis
Treatment of HZV
Neurotrophic Keratitis
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Lubricants – preservative free
Punctal occlusion
Bandage contact lens
Amniotic membrane – sutureless (Prokera,
Ambiodisc), sutured (cryopreserved, dehydrated)
Tarsorrhaphy
Conjunctival flap
Tissue adhesive
Corneal transplant
Zostavax
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Lyophilized preparation of live attenuated VZV
>60 years
Followed 3.1 years
Reduced incidence of HZV by 51.3%
Reduced incidence of PHN by66.5%
Reduced pain
Oxman et al, NEJM 2005; 352:2271-84
Zostavax
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ZEST Study
50-59 years
Followed 1.3 years
Reduced risk of developing HZV by 69.8
FDA approved 3/11 but CDC ACIP
recommends only for >60 years
Zostavax
 Persons
with previous zoster can
be vaccinated but safety and
efficacy have not been assessed