Viral
Usual Pathogens
Herpes simplex
- Debridement recommended.
- Topical corticosteroids are restricted to specific clinical presentations. Consult an ophthalmologist.
- ~30% rate of recurrence within 2 years. Secondary prophylaxis with acyclovir 400mg PO bid or valacyclovir 500mg PO daily x 1 year reduces recurrences.
Ophthalmic Gel
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ganciclovir 0.15% |
1 drop 5x/day, then 1 drop 3 times daily |
Until corneal ulcer heals, then tid for 7 days |
|
Consider adding oral antiviral in severely affected or immunocompromised patients, e.g. acyclovir 400 mg PO 5x/day or valacyclovir 1g po bid for 10 days. | ||
Varicella zoster
- Therapy ideally should be initiated within 72 hours of onset of skin lesions.
- Skin lesions on tip of nose generally result in corneal involvement.
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Famciclovir | 500mg PO tid | 10 days |
| or | ||
| Valacyclovir | 1g PO tid | 10 days |