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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/dayValacyclovir Treatment dose: 500 mg 3x/day
Prophylactic dose: 500 mg once dailyFamciclovir Treatment dose: 250 mg 3x/day
Prophylactic dose: 250 mg once daily or 125 mg 2x/dayTopical 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
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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
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Structure involved Acute phase Late phase Eyelid/conjunctiva Blepharitis
Conjunctivitis
Vesicular rashPtosis
Eyelid retraction
Secondary Staphylococcus aureus infectionEpisclera/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
RetinitisAcute retinal necrosis
Progressive outer retinal necrosisCranial 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
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Ocular finding Treatment Skin and lid vesicular lesions
Pain and hyperesthesia of ophthalmic
branch dermatomeOral 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
TarsorrhaphyUveitis Topical steroids
Oral steroids
Oral acyclovirEpiscleritis/scleritis Topical nonsteroidal anti-inflammatory agents and/or steroids Retinitis
Acute retinal necrosis
Progressive outer retinal necrosis
Cranial nerve involvementIntravenous 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
Figure 5 个
Table 4 个