Which medications in the drug class Antivirals are used in the treatment of Viral Conjunctivitis (Pink Eye)?

Updated: Mar 24, 2020
  • Author: Ingrid U Scott, MD, MPH; Chief Editor: Andrew A Dahl, MD, FACS  more...
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These agents are used for the treatment of HSV infection.

Trifluridine (Viroptic)

Trifluridine is a pyrimidine (thymidine) analogue drug of choice in the United States for topical antiviral therapy for HSV infection. It inhibits viral replication by incorporating into viral deoxyribonucleic acid (DNA) in place of thymidine. It is prescribed initially 9 times per day until resolution of the epithelial keratitis, then QID for another week. If the patient has no response in 7-14 days, consider other treatments. Trifluridine requires refrigeration and contains the toxic preservative thimerosal.

Ganciclovir ophthalmic (Zirgan)

Ganciclovir is a selective antiviral activated only within infected cells by viral thymidine kinase. It is a viral DNA chain terminator and DNA polymerase inhibitor. It is available in gel formulation and is stable at room temperature. It is prescribed 5 times per day until resolution of the epithelial keratitis, then TID for an additional week.

Acyclovir (Zovirax)

This is a prodrug that inhibits viral replication; it is activated by phosphorylation by virus-specific thymidine kinase. The recommended dosage for acute epithelial keratitis or stromal keratitis ranges from 200 mg PO BID to 400 mg PO TID. Some clinicians recommend the highest anti-zoster strength of 800 mg owing to the variability among patients in gastric absorption and the resultant variability and unpredictability of measurable serum concentrations.

Valacyclovir (Valtrex)

Valacyclovir is a prodrug that is rapidly converted to the active drug acyclovir. It produces a greater serum concentration of acyclovir with smaller oral dosing. Valacyclovir is more expensive than acyclovir but can be as effective with a more convenient dosing regimen.

Famciclovir (Famvir)

This agent is a prodrug that, when biotransformed into its active metabolite, penciclovir, may inhibit viral DNA synthesis/replication. It has been used successfully in the suppression of genital herpes. Its efficacy in HSV keratitis currently is under study.

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