Treatment: medical therapy

Purpose To present the current medical treatment of herpetic eye disease (HED). Methods Electronic search of PubMed using the terms randomized clinical trials, treatment, herpes, and eye was performed. Results For herpes simplex virus (HSV) epithelial keratitis, trifluridine and acyclovir are more effective than idoxuridine or vidarabine. Brivudine and ganciclovir are at least as effective as acyclovir. The effectiveness of corneal epithelial débridement is improved by an antiviral agent. For HSV stromal keratitis, topical corticosteroids in addition to a topical antiviral agent are effective in managing HSV stromal keratitis. Topical cyclosporine A in conjunction with prophylactic antivirals is an alternative treatment for HSV stromal keratitis, especially in cases of non‐necrotizing disease not controlled by corticosteroids or in cases with side effects from steroid treatment. In patients with necrotizing HSV stromal keratitis, amniotic membrane transplantation with postoperative antivirals and corticosteroids are recommended when antivirals alone do not control the disease. For HSV iridocyclitis, a study’s results show a trend for a benefit from oral acyclovir in addition to topical corticosteroids. For ophthalmic herpes zoster, oral antiviral drugs at the first signs of infection are recommended for all patients. The monotherapy with antiviral ointment is insufficient. For metaherpetic eye disease, antiviral agents are generally contraindicated and resurfacing therapy and/or surgical reconstruction should be considered. Conclusion Appropriate and timely treatment of different forms of HED benefits better visual prognosis and improved quality of life.