Usual Pathogens
Herpes simplex

- Debridement recommended.

- Topical corticosteroids are restricted to specific clinical presentations. Consult an ophthalmologist.

- ~30% rate of recurrence within 2 years.  Secondary prophylaxis with acyclovir 400mg PO bid or valacyclovir 500mg PO daily x 1 year reduces recurrences.

Ophthalmic Gel

Empiric Therapy Dose Duration
Ganciclovir 0.15%

1 drop 5x/day, then

1 drop 3 times daily

Until corneal ulcer heals, then

tid for 7 days

Consider adding oral antiviral in severely affected or immunocompromised patients,

e.g. acyclovir 400 mg PO 5x/day or valacyclovir 1g po bid for 10 days.


Varicella zoster

- Therapy ideally should be initiated within 72 hours of onset of skin lesions.

- Skin lesions on tip of nose generally result in corneal involvement.

Empiric Therapy Dose Duration
Famciclovir 500mg PO tid 10 days
Valacyclovir 1g PO tid 10 days