title: Development of Herpes Simplex Virus Infectious Epithelial Keratitis During Oral Acyclovir Therapy and Response to Topical Antivirals.
abstract: OBJECTIVE
  To describe 3 cases of herpes simplex virus (HSV) vesicular blepharitis that progressed to infectious epithelial keratitis despite treatment with oral acyclovir, but responded to topical antiviral therapy.
  
  
  METHODS
  Retrospective review of a small case series.
  
  
  RESULTS
  One adult and 2 children presented with unilateral HSV vesicular blepharitis without evidence of corneal involvement. Each patient was placed on a therapeutic dose of oral acyclovir. While taking oral antiviral therapy, the patients developed HSV infectious epithelial keratitis, which was treated with trifluridine 1% solution 9 times daily in the adult and ganciclovir 0.15% ophthalmic gel 5 times daily in the 2 children. All 3 cases showed resolution of epithelial keratitis within 3 to 10 days after initiation of topical antiviral treatment while oral acyclovir was continued.
  
  
  CONCLUSIONS
  Oral antiviral therapy alone may not adequately prevent progression of infectious ocular HSV blepharoconjunctivitis. Topical antiviral therapy appeared to enable resolution of HSV epithelial keratitis that arose during oral acyclovir treatment.
authors.affiliation: Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Medical Center, New York, NY.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Carter
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Cohen
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001762:Blepharitis / Q000188:drug therapy* / Q000821:virology; D002648:Child; D003236:Conjunctivitis, Viral / Q000188:drug therapy* / Q000821:virology; D018450:Disease Progression; D019573:Epithelium, Corneal / Q000473:pathology* / Q000821:virology; D015828:Eye Infections, Viral / Q000188:drug therapy* / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D016849:Keratitis, Herpetic / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D008297:Male; D012189:Retrospective Studies; D014271:Trifluridine / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir; D014271:Trifluridine; D000212:Acyclovir