Figure 5个  Table 4
    • Oral antivirals Dosage
      Acyclovir Treatment dose for adults: 400 mg 3–5x/day
      Treatment dose for children: 12–15 mg/kg/day in several doses
      Prophylactic dose: 400 mg 2x/day
      Valacyclovir Treatment dose: 500 mg 3x/day
      Prophylactic dose: 500 mg once daily
      Famciclovir Treatment dose: 250 mg 3x/day
      Prophylactic dose: 250 mg once daily or 125 mg 2x/day
      Topical antivirals Treatment dosage
      Trifluridine 1% drop One drop every 2 hours, reduced to 5x/day after 3–7 days
      Ganciclovir 0.15% gel 5x/day
      Vidarabine 3% ointment 5x/day

      Table  1.  Dosage of antiviral agents

    • Ocular finding Basic treatment approach
      Epithelial keratitis Topical or oral antiviral with possible debridement
      Stromal keratitis without ulceration (immune stromal keratitis) Topical steroid with prophylactic oral antiviral
      Stromal keratitis with ulceration (necrotizing keratitis) Oral antiviral in therapeutic doses with topical steroid
      Endotheliitis (endothelial keratitis) Oral antiviral in therapeutic doses with topical steroid
      Neurotrophic keratopathy (neurotrophic keratitis) Topical lubrication, soft contact lenses, tarsorrhaphy

      Table  2.  Treatment strategies for ocular HSV

    • Structure involved Acute phase Late phase
      Eyelid/conjunctiva Blepharitis
      Vesicular rash
      Eyelid retraction
      Secondary Staphylococcus aureus infection
      Episclera/sclera Episcleritis Self-limiting
      Scleritis Focal sectoral atrophy
      Cornea Epithelial (punctate or dendritic) keratitis Neurotrophic keratopathy
      Stromal keratitis Corneal neovascularization
      Anterior chamber Uveitis Focal iris atrophy
      Secondary glaucoma
      Ocular hypertension Usually self-limiting
      Retina Retinal vasculitis
      Acute retinal necrosis
      Progressive outer retinal necrosis
      Cranial nerves Optic neuritis Optic atrophy
      Oculomotor muscle palsies Self-limiting
      * Adapted from Opstelten W, et al.(2005), Rocha G, et al.(2010), and Shaikh S, et al.(2002).

      Table  3.  Treatment strategies for ocular HSV

    • Ocular finding Treatment
      Skin and lid vesicular lesions
      Pain and hyperesthesia of ophthalmic
      branch dermatome
      Oral acyclovir (800 mg 5x/day) for 7–10 days, valacyclovir (1000 mg 3x/day) for 7 days, or famciclovir (500 mg 3x/day) for 7 days
      Epithelial keratitis Gentle debridement or no treatment
      Stromal keratitis Topical corticosteroid and cycloplegic agent
      Neurotrophic keratitis Topical lubrication
      Topical antibiotics for secondary infections
      Protective contact lenses to prevent corneal perforation
      Uveitis Topical steroids
      Oral steroids
      Oral acyclovir
      Episcleritis/scleritis Topical nonsteroidal anti-inflammatory agents and/or steroids
      Acute retinal necrosis
      Progressive outer retinal necrosis
      Cranial nerve involvement
      Intravenous acyclovir (1500 mg per m2/day divided into 3 doses) for 7–10
      days followed by oral acyclovir (800 mg, 5x/day) for 14 weeks
      Systemic steroids
      Laser/surgical intervention if needed
      * Adapted from Shaikh S, et al.(2002), Tyring S K, (2006).

      Table  4.  Treatment for Herpes Zoster Ophthalmicus