Treatment of Pseudodendrites in Herpes Zoster Ophthalmicus With Topical Ganciclovir 0.15% Gel

Abstract

Topical 0.15% ganciclovir gel, 5 times a day until pseudodendritic lesion healing and tapering to bid for 2 to 4 weeks thereafter, is an effective treatment for pseudodendrites in HZO-affected cases that are often a challenge to manage with other oral or topical antivirals.

Development of Herpes Simplex Virus Infectious Epithelial Keratitis During Oral Acyclovir Therapy and Response to Topical Antivirals

“…16 In 4 patients who developed corneal epithelial dendriform keratitis despite administration of oral valacyclovir, treatment with ganciclovir 0.15% gel resulted in healing.…”

Persistent dilemmas in zoster eye disease

“…In 1995, a study showed that late epithelial dendriform keratitis lesions were often PCR-positive for VZV, and this was confirmed in 2010 by a larger series 61 62. Dendriform keratitis’ response to antiviral treatment is further evidence that it is caused by active VZV infection 58 62. VZV DNA has been found to persist in the saliva of 67% (21/32) of people with a past history of HZ up to 12 years after disease onset,70 but not in the saliva of healthy people 71…”

“…Long-term topical corticosteroids are needed to control stromal keratitis, endothelialitis and/or uveitis in most patients with chronic HZO disease (figures 2, 3A, B, 4 and 5). Effective treatment for dendriform keratitis is topical gangciclovir five times a day for 2 weeks and then twice daily for 2–4 weeks 58. Use of long-term suppressive oral antivirals is highly variable 59…”

Current Practice Patterns and Opinions on the Management of Recent-Onset or Chronic Herpes Zoster Ophthalmicus of Zoster Eye Disease Study Investigators

“…1–6 Dendriform lesions respond to topical and systemic antiviral treatment. 6,7 In addition, corneas removed from HZO patients during transplantation have been found by PCR to have specific VZV genomic DNA sequences up to 51 years after HZO onset. 8 Furthermore, the Acyclovir Prevention Trial of the Herpetic Eye Disease Study (HEDS) determined that prolonged suppressive antiviral treatment significantly reduced recurrent eye disease caused by Herpes Simplex Virus (HSV), a different herpes virus, and was most beneficial in stromal keratitis, a disease manifestation considered to be immune mediated with the role of active viral infection unknown.…”