Viral (including atypical) eye infections

Preferred 

ganciclovir 0.15% eye gel five times daily 7-10 days (or continue for at least 3 days after complete healing)

• Women of childbearing potential when prescribed ganciclovir 0.15% eye gel must be advised to use effective contraception during treatment. 
• Men with partners of childbearing potential using ganciclovir 0.15% eye gel should be advised to use barrier contraception during and for at least 3 months after the end of treatment.

If oral antivirals are indicated ADD:

valaciclovir 500mg po bd for 5 days, or longer if new lesions appear during treatment or healing is incomplete.

• If immunocompromised: Use 1g po bd for 10 days 

OR

aciclovir 200mg po five times a day for 5 days or longer if new lesions appear during treatment or healing is incomplete.

• If immunocompromised: Use 400mg po five times a day for 5 days or longer if new lesions appear during treatment or healing is incomplete

Preferred

valaciclovir 1g po tds for 7 days (if immunocompromised - at least 7 days and continued for 2 days after crusting of lesions).  

AND

ganciclovir 0.15% eye gel five times daily  

• Women of childbearing potential when prescribed ganciclovir 0.15% eye gel must be advised to use effective contraception during treatment. 
• Men with partners of childbearing potential using ganciclovir 0.15% eye gel should be advised to use barrier contraception during and for at least 3 months after the end of treatment.

Second-line

aciclovir 800mg po five times a day for 7 days (if immunocompromised - continued for 2 days after crusting of lesions) 

AND

ganciclovir 0.15% eye gel five times daily  

• Women of childbearing potential when prescribed ganciclovir 0.15% eye gel must be advised to use effective contraception during treatment. 
• Men with partners of childbearing potential using ganciclovir 0.15% eye gel should be advised to use barrier contraception during and for at least 3 months after the end of treatment.

AC tap only.

Inject intravitreal foscarnet 2.4mg in 0.1ml PLUS aciclovir po 800mg five times a day

AC tap only.

Inject intravitreal foscarnet 2.4mg in 0.1ml.  

For possible syphilis (consider neurosyphilis)  

Add benzylpenicillin 2.4g iv every 4 hours and consult Micro/ID  

For possible ocular toxoplasmosis see Ocular Toxoplasmosis and consult Micro/ID

AC Tap plus Vitreous Tap  

Inject intravitreal vancomycin AND ceftazidime as per endopthalmitis protocol.

Preferred systemic management:

Herpes Simplex Virus (HSV)/ Varicella Zoster Virus (VZV) suspected: 

valaciclovir 1g po tds   

PLUS

ganciclovir 0.15% gel five times a day  

• Women of childbearing potential when prescribed ganciclovir 0.15% eye gel must be advised to use effective contraception during treatment. 
• Men with partners of childbearing potential using ganciclovir 0.15% eye gel should be advised to use barrier contraception during and for at least 3 months after the end of treatment.

CMV suspected:  

valganciclovir 900mg po bd for 3 weeks then 900mg po od for maintenance   

WITH OR WITHOUT

intravitreal foscarnet 2.4mg in 0.1ml