Painful facial blisters, fever, and conjunctivitis

Standard Tx: Antiviral medications

Topical antiviral therapy is the standard treatment for epithelial HSV keratitis, although oral antiviral medications are equally effective. A randomized trial found that using an oral agent in addition to a topical antiviral did not improve outcomes.⁸ A 2015 systematic review found that topical antivirals acyclovir, ganciclovir, brivudine, trifluridine were equally effective in treatment outcome; 90% of patients healed within 2 weeks.⁹

Recurrent ocular HSV-1 infections are treated in the same way as the initial infection. Recurrent infection can be prevented with daily suppressive therapy. In one study, patients who took suppressive therapy (acyclovir 400 mg bid) for 1 year had 19% recurrence of ocular infection vs 32% in the placebo group.¹⁰

It’s always better to consider a diagnosis of primary oral HSV infection than to treat candida and pain with a mixed medication mouthwash.

Prompt Tx is key. If the infection is superficial—involving only the outer layer of the cornea (epithelium)—the eye should heal without scarring with proper treatment. However, if the infection is not promptly treated or if deeper layers are involved, scarring of the cornea may occur. This can lead to vision loss or blindness.

Continue to: A missed opportunity for an earlier diagnosis