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Medications used in the treatment of viral conjunctivitis include the following: topical artificial tears, 4-8 times per day, for 1-3 weeks;
topical vasoconstrictor/antihistamine, 4 times per day, for severe itching; topical steroids for pseudomembranes and subepithelial infiltrates;
topical antibiotic to prevent bacterial superinfection; topical antiviral agents for HSV infection; and oral acyclovir for VZV infection.
Drug Category: Ocular lubricants
Used for symptomatic relief.
Drug Name Artificial tears (Refresh, Celluvisc, Murine)
Description Act to stabilize and thicken precorneal tear film and prolong tear film breakup time, which occurs with dry eye states.
Adult Dose 1-2 gtt 4-8 times/d; may use more frequently if preservative free
Pediatric Dose Administer as in adults
Contraindications Documented hypersensitivity
Interactions None reported
Pregnancy A - Safe in pregnancy
Precautions Hyperemia, photophobia, stickiness of eyelashes, and ocular discomfort or irritation may occur
Drug Category: Antihistamines
Used to treat severe itching.
Drug Name Levocabastine (Livostin)
Description Potent histamine H1-receptor antagonist; for ophthalmic use.
Adult Dose 1 gtt in each affected eye qid
Pediatric Dose <12 years: Not established
>12 years: Administer as in adults
Contraindications Documented hypersensitivity
Interactions None reported
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Shake well prior to use; not for internal (systemic) use; avoid use of contact lenses while on medication
Drug Category: Corticosteroids
For pseudomembranes and decreased vision and/or glare due to subepithelial infiltrates. Have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.
Drug Name Prednisolone (AK-Pred, Pred Forte)
Description Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Less potent (eg, prednisolone 0.125%, fluorometholone 0.1%) are usually sufficient to treat subepithelial infiltrates. The steroid must be tapered very slowly, over months.
Adult Dose 1 gtt q1-6h, depending on severity of infection; taper slowly over several d to wk
Pediatric Dose Administer as in adults
Contraindications Documented hypersensitivity; HSV keratitis; acute viral keratitis; VZV; suspected fungal keratitis; mycobacterial infection; glaucoma
Interactions None reported
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Caution in patients with glaucoma; corticosteroids are associated with increased intraocular pressure and cataract in some patients; they may worsen certain infections, such as from herpes simplex, bacteria, and fungi
Drug Category: Antivirals
Used for the treatment of HSV infection.
Drug Name Trifluridine (Viroptic)
Description Pyrimidine (thymidine) analogue DOC in the United States for topical antiviral therapy for HSV infection. Inhibits viral replication by incorporating into viral DNA in place of thymidine. If no response in 7-14 d, consider other treatments.
Adult Dose 1 gtt into affected eye q2h while awake; not to exceed 9 gtt/d for 10 d, not to exceed 21 d; taper thereafter
Pediatric Dose Administer as is adults
Contraindications Documented hypersensitivity
Interactions None reported
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions All topical antiviral medications currently available for clinical use in the United States are toxic; adverse reactions include discomfort upon instillation and palpebral edema, irritation, and superficial punctate or epithelial keratopathy
Drug Name Acyclovir (Zovirax)
Description Prodrug activated by phosphorylation by virus-specific thymidine kinase that inhibits viral replication.
Adult Dose Herpes zoster ophthalmicus: 800 mg PO 5 times/d for 7-10 d
Recurrent episodes: 400-800 mg PO bid for 7-10 d; initiate treatment immediately upon onset of symptoms of recurrent episodes
Prevention of herpes simplex infections: 400 mg PO bid, can be used to prevent recurrent herpes simplex infections and inflammations
Pediatric Dose 20 mg/kg/dose PO q6h up to a maximum of 800 mg
Contraindications Documented hypersensitivity; caution in renal disease
Interactions Concomitant use of probenecid or zidovudine prolongs half-life and increases CNS toxicity of acyclovir
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Caution in renal failure or when using nephrotoxic drugs
С уважением, Дарина.