Herpes Zoster Ophthalmicus
I am 70 year old male. I got Herpes Zoster Ophthalmicus on the left eye since 10th of march. I have already finished antiviral (Acyclovir 800mg - 5 times a day for 10 days, also 2 tablets a day for 8 days and 3 tablets for 14 days course and also taking suitable eye drops and ointments for my eye infection.
Till now I have taken more than 96 Tablets of Acyclovir. What is standard dosage of Acyclovir ? Have I taken over dosage?
Now I am better and almost recovering. As per advise of my Neurologist I am taking Antidepressant and Epilepsy tablets to manage my pain and my pain has reduced.
My left eye was better but since last week again its become red and lids are very sensitive and they are burning. My eye doctor says its due to blepharitis and he has prescribed me Ciprofoxacin tablets and ointments and also suggested me to restart Acyclovir 800 mg 3 tablets per day for 4 weeks.
Also what is dosage of Acyclovir as I have already taken more than 100 tablets? Also my problem is that I am unable to find a doctor who knows overall treatment for the Herpes.
Can it recur? How can I prevent this? Any vaccines are available? Will the vaccines help me to get rid of herpes ?
Thanks for your question
Herpes Zoster Ophthalmicus occurs in old age and it has skin manifestations (skin rash and vesicles) and ocular manifestations ( dendritic keratitis) and also neurological manifestations. In its acute stage, it can be treated with oral Acyclovair 800 mg five times a day for 10-21 days( Within 73hrs from the beginning of rashes) which is enough to induce prompt resolution of the skin rash and pain.
It also help to induce more rapid healing, reduce the duration of viral shedding, reduce the incidence and severity of acute dendritiform keratopathy and the incidence of late onset stromal keratopathy.
Late-onset ocular manifestations such as immune keratitis, scleritis, iritis and uveitis can be treated with steroid medications +/- acyclovair( oral or intravenous). Topical Acyclovair shouldn't be used more than 10 days because it is toxic to the epithelial cells and can cause severe eye redness and irritation.
It is advisable to have ocular examination every 4-6 months because ocular manifestations can be sometimes asymptomatic.
Recurrence of skin manifestations also can occur and this requires oral acyclovair in the same dose as the first time.
Blepharitis and conjunctivitis consider as mild complications of Herpes Zoster virus and they can be treated with cool compresses,lid hygiene, topical artificial tears and topical antibiotics. There is no need for acyclovair if Blepharitis/conjunctivitis is not associated with skin rashes or vesicles, immune keratitis, uveitis or retinal involvement.
Oral antiviral prophylaxis of 400 mg twice a day for 1 year has been a regimen for Herpes Simplex Virus with ocular involvement and there is no enough data if this regimen can be used as a prophylaxis in patients with Herpes Zoster. It is advisable to contact your eye doctor and discuss this issue with him.
Unfortunately, there is no cure for herpes virus. The primary infection with this virus occurred during childhood and the virus stayed inactive in neurons and for many factors it becomes active again. Primary infection usually comes in flu-like illness with or without skin rashes but the secondary infection has skin and ocular manifestations.
There is vaccination for Herpes Zoster Virus, it helps to reduce the burden of infection by 61%, reduce the incidence of post-herpetic neurolagia by 66% and also reduce the incidence of herpes zoster by 51%. It has be approved by FDA for adults over 60 Years. For how long this vaccination still active still unknown