Corneal infection

For general guidance on administration of drugs to the eye and on control of microbial contamination of eye drops, please see the ‘General information on eye drops’ recommendations.

NICE CKS: Herpes simplex - ocular

Treat with ganciclovir eye gel with or without oral aciclovir. Oral aciclovir is used where the ophthalmologist notes deeper ocular involvement or recurrent HSV infections.

Apply 5 times a day until healing complete, then apply 3 times a day for a further 7 days, treatment does not usually exceed 21 days.

200mg 5 times daily for 7 days (increase to 400mg 5 times daily if immunocompromised.) 400mg twice daily maintenance dose to prevent recurrence.

Prescribing Notes:

During treatment with ganciclovir women of childbearing age should use effective contraception and men with partners of childbearing age should be advised to use barrier contraception during and for at least 90 days after treatment.
NICE CKS guidance on ocular herpes simplex advises to refer all cases of suspected ocular herpes simplex infection to Eye Casualty or an emergency eye service for same-day assessment and specialist management. Do not initiate drug treatment while awaiting specialist ophthalmology assessment.

History Notes

15/12/2021

East Region Formulary content agreed.

Refer to community optometry/ophthalmology at presentation of infection.

For a simple dendritic ulcer, treat with topical aciclovir and refer to community optometry.

See BNFc for dose and duration.

Deeper forms of corneal infection (e.g. stromal keratitis) or recurrent HSV keratitis will require oral aciclovir.
Aciclovir tablets may be dispersed in a minimum of 50ml of water or swallowed whole with a little water. Oral suspension is more expensive, reserve for when dose is <200mg, or if tablets are not tolerated.

See BNFc for dose and duration.

Prescribing Notes:

NICE CKS: Herpes simplex ocular advises to refer all cases of suspected ocular herpes simplex infection to Eye Casualty or an emergency eye service for same-day assessment and specialist management.
A simple dendritic ulcer, in a child may be treated by a community optometrist with appropriate training and expertise where they feel confident to do so, alternatively refer to hospital (ophthalmology). Deeper forms of corneal infection (e.g. stromal keratitis) or recurrent HSV keratitis warrant specialist ophthalmology treatment.

History Notes

15/01/2024

East Region Formulary content agreed.