Oral acyclovir for herpes zoster ophthalmicus

Area of Science:

• Ophthalmology
• Virology
• Infectious Diseases

Background:

• Herpes zoster ophthalmicus (HZO) can lead to severe morbidity, including eyelid scarring, ocular complications, and post-herpetic neuralgia.
• Early oral acyclovir treatment is effective for HZO, but optimal treatment duration remains undefined.

Purpose of the Study:

• To determine if a 14-day course of oral acyclovir is more effective than a 7-day course for treating acute herpes zoster ophthalmicus.
• To evaluate the impact of oral acyclovir duration on HZO-related morbidity and post-herpetic neuralgia.

Main Methods:

• A bicentric, prospective, randomized, double-masked study involving 86 patients with acute HZO treated within 72 hours of rash onset.
• Patients received oral acyclovir (800 mg 5 times daily) for either 7 days (plus 7 days placebo) or 14 days, with concomitant topical acyclovir ointment.
• Follow-up was conducted for at least 6 months to assess outcomes.

Main Results:

• No significant differences in subjective symptoms, skin lesions, or ocular complications were observed between the 7-day and 14-day treatment groups.
• Prompt oral acyclovir treatment reduced the severity of skin eruption, late ocular manifestations (29.1% vs. 50-71% in historical controls), and post-herpetic neuralgia (13% incidence).
• Drug tolerance was good, with no significant adverse events reported.

Conclusions:

• A 7-day course of oral acyclovir (800 mg 5 times daily) is sufficient for treating herpes zoster ophthalmicus.
• Oral acyclovir demonstrates efficacy in managing HZO skin lesions, ocular complications, and preventing post-herpetic neuralgia.