What are the IASP recommendations for the management of herpes zoster ophthalmicus (HZO)?

Updated: Feb 11, 2021
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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The 2007 International Association for the Study of Pain (IASP) recommendations for the management of herpes zoster ophthalmicus are as follows [1] :

  • Famciclovir or valacyclovir for 7-10 days, with intravenous acyclovir given as needed for retinitis

  • Pain medications, as for immunocompetent patients

  • Cool-to-tepid wet compresses (if tolerated)

  • Antibiotic ophthalmic ointment administered twice daily (eg, bacitracin-polymyxin) to protect the ocular surface

  • Topical steroids (eg, 0.125-1% prednisolone 2-6 times daily) prescribed and managed only by an ophthalmologist for corneal immune disease, episcleritis, scleritis, or iritis

  • No topical antivirals

  • Mydriatic/cycloplegia as needed for iritis (eg, 5% homatropine twice daily)

  • Ocular pressure–lowering drugs given as needed for glaucoma

  • Systemic steroids indicated in the presence of moderate to severe pain or rash

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