Viral Eye Disease Treatment

Question 1

What are the 3 main viral pathogenic causes seen in eye care and associated risks of non-Tx?

Answer 1

Herpes simplex - corneal scarring and stromal keratitis

Herpes Zoster - post-herpetic neuralgia and immune-mediated keratouveitis

Adenovirus - subepi infiltrates that can take months/years to clear

Question 2

What is the best treatment for delayed response inflammatory keratitis or keratouveitis?

Answer 2

Steroid suppression (with antiviral cover for simplex)

Question 3

When you encounter an older patient who complains of temporal/facial skin pain and headache, what two possibilities should immediately come to mind?

What should you do?

Answer 3

impending Zoster or GCA

Order see rate and CBC/CRP with Rx for oral antiviral and advise Pt to start meds as soon as vesicles develop

Question 4

What are antiviral Tx for herpes simplex? Pros and cons of both

Answer 4

Virpotic (outdated) - q2h/day x 4 days then aid x 4 days; risk of surface toxicity

Zirgan (newer) - 5x/day dose x 4 days then rid x 4 days; less surface toxicity

oral acyclovir - least expensive and dosed 400mg 5x/day x 1 week

Question 5

T/F Topical and oral antiviral tx are used to treat herpetic eye disease

Answer 5

Well . . . only in the most severe of cases

Question 6

What is the treatment for chronic, recurrent epithelial or stromal herpetic disease?

Answer 6

5 year disease free course of acyclovir bid for prophylaxis

Or

5 years of 500mg of oral valacyclovir qd (more expensive)

Question 7

What is Zostavax?

Answer 7

Vaccine for patients >50YO that reduces incidence by 50% and significantly reduces clinical course if infected

Question 8

What is treatment for herpes zoster?

Answer 8

Almost always inflammatory uveitis and/or keratitis

Treat with:

1) topical corticosteroids: Durezol or Pred Forte along with cycloplegia
2) oral antivirals (Acyclovir, valacyclovir, famciclovir)

Question 9

What is a caution of oral antivirals?

Answer 9

Mechanism of excretion is via kidneys, so if a patient has advanced renal compromise, it will take less drug to achieve comparable therapeutic dosing (call pt’s kidney physician and find creatinine function and GFR. Then call pharmacy to get dosage conversion to get proper dose of chosen antiviral - or just chat with treating physician)

Question 10

What are the oral antivirals used to treat zoster and associated dosages?

Answer 10

Acyclovir: 800mg 5x/day x 1 week

Valacyclovir: 1000 mg tid x 1 week

Famciclovir: 500mg tid x 1 week

All are generic but acyclovir is always the least expensive

Question 11

T/F Topical antiviral therapy for zoster infections for cover is always indicated

Answer 11

False - and there is also no need for cover when treating globe with topical steroids

Question 12

When is the oral zoster antiviral tx most effective?

Answer 12

Within the first 5-7 days, but do not delay as they are only slightly subdued

Question 13

What are the 2 forms of adenovirus and what groups are most affected?

Answer 13

pharygoconjunctival fever (PCF) - children present with unilateral red eye with watery discharge, low grade sore throat and fever

EKC - everyone! More virulent!

Question 14

What is the treatment for PCF?

Answer 14

Mild steroid: FML or Alrex qid x 4 days; bid x 4 days;

Question 15

What is the treatment for EKC?

Answer 15

Treating the secondary inflammatory conjunctivitis:

Loteprednol (ester based) will clear SEI if used qid x 2-4 weeks; tid x 2-4 weeks; bid x 2-4 weeks