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Question:
My 10-year-old son suffers regularly from ocular herpes (averaging 2 to 3 times a year for the past 5 years). He is now always prescribed Acyclovir eye ointment when it occurs. What would be your advice to help prevent outbreaks? Are there any immunizations that may help strengthen his immune system against the virus?

Answer:
This is a tough problem for you and your son, and a persistent, recurrent problem without a definitive cure. There is, however, treatment which can help him.

Ocular herpes simplex virus is the same herpes virus that causes cold sores on or near the mouth and is very common.

Primary herpes, the initial infection, is usually seen in children, and then can reoccur at any time. One out of four people with herpes in the eye get a recurrence in the first year and 2 out of 4 see a reoccurrence within 5 years of the initial infection. Reoccurrence is a problem because each time it happens, it scars the cornea — the clear windshield of the eye — and can diminish vision.

There are three approaches:

  • Prevent the triggers which cause recurrence: Some triggers for recurrence are fever, illness, UV light or sunburn/windburn. Treating fever with Tylenol, and wearing sunglasses and a broad-brimmed hat can help.
  • Oral anti-viral preventive treatment: An ongoing regimen of low dose oral anti-viral tablets such as Acyclovir, has been shown to reduce both the frequency and severity of recurrence. You will want to discuss this with your ophthalmologist.
  • Very slow taper of topical steroid drops: Some patients need to be on long term very low-dose steroid drops — sometimes for years — to prevent recurrence.

Usually acyclovir eye ointment is used in primary infections, and trifluridine anti-viral eye drops are used in reoccurrence. Long term use of trifluridine eye drops can cause inflammation and toxicity in the eye, looking like persistent infection.

Make sure you are seeing an ophthalmologist, or Eye M.D., who is comfortable with pediatric corneal disease. Ask about the long-term plan for your son. If you haven’t done so already, consider a second opinion from an ophthalmologist who specializes in diseases of the cornea.

Answered by: Anne Sumers, MD Dr. Anne Sumers 

Categories: Children's Eye Health, Eye Diseases

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Answered: Aug 25, 2014

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