Refer to Ophthalmologist immediately. Oral aciclovir should be prescribed immediately for ophthalmic zoster.

Antimicrobial recommendations

Aciclovir 800mg 5 times daily orally for 7 days. 

In the immunocompromised or where oral route is not available.

Aciclovir 10 mg/kg every 8 hours for 5 days

On the advice of ophthalmologist

  • Consider Ganciclovir eye gel 0.15%: apply 5 times a day until healing complete, then apply 3 times a day for a further 7 days, treatment does not usually exceed 21 days.
    • During treatment with ganciclovir eye gel, women of childbearing age should use effective contraception during treatment, and men with partners of childbearing age should be advised to use barrier contraception during and for at least 90 days after treatment.
  • Consider Aciclovir oral 400mg twice daily maintenance dose to prevent recurrence.

Notes

See NICE CKS guidance on shingles for further information.

HIV testing is recommended in line with national guidance.