Herpes zoster ophthalmicus
ICD-10 B02.3 · ICD-11 1E91.1
Treatment of Herpes Zoster Ophthalmicus with Anterior Uveitis or Stromal Keratitis of the Cornea
When herpes zoster ophthalmicus (HZO) is complicated by anterior uveitis or stromal keratitis of the cornea, management requires a combined approach that addresses both the underlying infection and the associated ocular inflammation.
Clinical scenario
This protocol covers HZO patients who develop anterior uveitis or stromal keratitis — complications that require specific ocular measures alongside antiviral treatment.
Approach
Management involves oral antiviral therapy combined with topical agents targeting the associated intraocular inflammation. The complete regimen — including specific agents, dosing, and duration — is defined in the full protocol.
References
- Topical corticosteroids (e.g. prednisolone acetate (Pred Forte®) 1% 4–6 times daily) along with cycloplegic agents (e.g. cyclopentolate 1%, 2 to 3 times daily) in cases of anterior uveitis or stromal keratitis (once HSV, bacterial and acanthamoeba keratitis have been ruled out).
- The standard dosage of acyclovir for herpes zoster infections in adults is 800 mg five times a day (at approximately 4 hourly intervals).
- Treatment should continue for 7–14 days.
- The standard treatment regimen for valacyclovir is 1000 mg, three times per day for 7–14 days, and for famciclovir, it is 500 mg per day for 7 days.