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Antiviral drugs ‘critical’ in preventing blindness, study shows

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ROCHESTER, Minn. — Oral antiviral medications are “critical” in preventing long-term consequences for patients with ocular shingles, according to a Mayo Clinic study.

Authors note this study contradicts findings of a British study on oral antiviral medications in patients with eye shingles.

Keith Baratz, MD, and colleagues here identified all Olmsted County, Minn., residents diagnosed with acute herpes zoster ophthalmicus. They compared the frequency of complications within 6 months of disease onset between untreated patients and patients treated with antiviral medications. For the purposes of this study, complications were defined as ocular sequelae due to herpes zoster ophthalmicus. Adverse outcomes included visual acuity of 20/200 or worse, trichiasis or eyelid malposition requiring surgical treatment. A total of 323 patients met all inclusion criteria.

Of the patients, 202 had been treated with oral antiviral medications (acyclovir, GlaxoSmithKline). Of those patients who received antiviral medication, conjunctivitis was significantly more prevalent. In the patients who did not receive antiviral medication, neurotropic keratitis was a more common complication.

In untreated patients, 8.9% experienced adverse outcomes 5 to 10 years following the onset of the disease; 2.1% of treated patients experienced similar outcomes. Timing of the treatment also affected the long-term outcome, according to Dr. Baratz. “Those who experienced long-term negative outcomes such as glaucoma, scleritis, uveitis, corneal edema or stromal keratitis had waited an average of 4.8 days before receiving treatment; those who did not experience those outcomes waited an average of 3.8 days before treatment,” he said.

Dr. Baratz notes this study contradicts findings from other studies on the effects of acyclovir on the ocular complications of herpes zoster ophthalmicus. “Our data revealed a tendency for less frequent inflammatory, short-term complications in patients treated with antiviral therapy,” the authors wrote in the March issue of Archives of Ophthalmology.