Table 4.

Antiviral treatment options for herpes zoster ophthalmicus (caused by varicella zoster virus)

Drug	Dose / regimen	Comments and evidence for use
Systemic aciclovir	Aciclovir 800 mg orally five times a day for seven days	For non-ocular involvement at onset, treatment must start within 72 hours of onset of blisters in order to alter disease course13 For ocular disease, start as soon as possible Antiviral treatment reduces the risk of chronic ocular complications from 30% to 20%14 Reduces duration of pain due to post-herpetic neuralgia (PHN) by 50% although no reduction in risk of developing PHN14 Consider using intravenous aciclovir in HIV infected patients due to the risk of disseminated varicella zoster virus infection
Topical aciclovir	Aciclovir 3% ointment, five times a day for seven days, then twice a day until dendrites have resolved	Use in the presence of dendritic keratitis but only in addition to systemic antiviral treatment. Add a topical steroid if there is stromal disease or keratitis15
Topical ganciclovir	Ganciclovir 0.15%, five times a day until the ulcer has healed	Use in the presence of dendritic keratitis only in addition to systemic antiviral treatment. Add a topical steroid if there is stromal disease or keratitis
Systemic valaciclovir	1 g orally three times a day for seven days	Alternative to aciclovir. Higher serum concentrations following oral administration, due to better bioavailability, means more convenient dosing (3 times a day vs 5 times a day) Potentially better than aciclovir in reducing acute pain16
Systemic famciclovir	500 mg orally three times a day for seven days	Alternative treatment options to aciclovir. Higher serum concentrations following oral administration, due to better bioavailability, means more convenient dosing (3 times a day vs 5 times a day) Potentially better than aciclovir in reducing acute pain17