The Herpetic Eye Disease Study (HEDS) has some great clinical pearls.
1. There is a benefit of using oral Acyclovir to Tx epithelial keratitis
2. No benefit of oral Acyclovir to Tx stromal keratitis (Stromal keratitis can be treated with topical steroids)
3. No benefit to add oral Acyclovir + trifluridine to Tx stromal keratitis.
4. No benefit to add oral Ayclovir + Trifluridine + Topical Steroids to Tx herpes stromal keratitis or Iridocyclitis.
5. Oral acyclovir, as part of the treatment of epithelial keratitis, does not reduce the future risk of developing stromal keratitis.
6.Prophylactic – 400mg Acyclovir BID for one year
a. Reduces recurrence rate of any HSV by 38%
b. Reduces recurrence rate of stromal HSV by 50%
c. Reduces recurrence rate or conjunctivitis and bleph 2* to HSV