Which medications in the drug class Antivirals, Ophthalmic are used in the treatment of Corneal Ulcer and Ulcerative Keratitis in Emergency Medicine?

Updated: Aug 05, 2019
  • Author: Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Antivirals, Ophthalmic

Therapy of viral infections begins with mechanical debridement of the involved rim along with a rim of normal epithelium. This is followed by the topical instillation of antiviral medications.

Trifluridine ophthalmic (Viroptic)

A structural analogue of thymidine, this agent inhibits viral DNA polymerase. Viroptic has better penetration through the cornea and greater efficacy (95% heal rate) than other topical agents.

Ganciclovir ophthalmic (Zirgan)

Acyclic nucleoside analogue of 2'deoxyguanasine. Phosphorylates first to monophosphate form by viral-encoded protein kinase homologue, then to diphosphate and triphosphate forms by cellular kinases, allowing for greater concentration of ganciclovir in virus-infected cells, possibly due to preferential phosphorylation of ganciclovir in virus-infected cells. Thought to inhibit HSV replication by competitive inhibition of viral DNA polymerases and by incorporating itself into viral DNA, causing termination of viral DNA elongation. Like acyclovir, ganciclovir is virostatic and exerts its effect only on replicating virus.

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