Treatment of herpes simplex keratitis
Keratitis is the most common ocular manifestation of herpes simplex virus (HSV); for assessment, see Assessment of infectious keratitis. Presentations of herpes simplex keratitis include dendritic ulcer, geographical ulcer, stromal keratitis, and endothelial keratitis.
Promptly refer patients with suspected herpes simplex keratitis to an ophthalmologist for assessment and treatment. While awaiting ophthalmology review, start topical treatment with aciclovir eye ointment. Topical therapy is preferred to oral therapy because it ensures a higher concentration of the antiviral is in contact with the eye. To treat dendritic ulcer in adults, while awaiting ophthalmology review, use:
aciclovir 3% eye ointment topically into the affected eye, 5 times daily for 10 to 14 days, or for at least 3 days after healing, whichever is shorter. aciclovir aciclovir aciclovir
If aciclovir eye ointment is not available, use oral antiviral therapy to treat dendritic ulcer in adults. Suitable regimens for adults who are immunocompetent are:
1valaciclovir 500 mg orally, 12-hourly for 7 to 10 days. For dosage adjustment in adults with kidney impairment, see valaciclovir dosage adjustment valaciclovir valaciclovir valaciclovir
OR
2aciclovir 400 mg orally, 5 times daily for 7 to 10 days. For dosage adjustment in adults with kidney impairment, see aciclovir oral dosage adjustment. aciclovir aciclovir aciclovir
Other forms of herpes simplex keratitis (geographical ulcer; stromal keratitis; endothelial keratitis and associated uveitis) should also be diagnosed and managed in conjunction with an ophthalmologist.
For recurrent herpes simplex keratitis, consider long-term suppressive oral antiviral therapy – seek ophthalmologist advice.
Seek expert advice for management of herpes simplex keratitis in children. In neonates, herpes simplex infection is always treated with intravenous therapy – see Neonatal herpes simplex infection.