The use of oral acyclovir (Zovirax®) has proven effective in the treatment of both ocular and nonocular manifestation of herpes simplex virus and varicella zoster virus. The usual regimen for herpes simplex virus is 400 mg 5 times daily. Unlike most oral anti-infectives, acyclovir is able to reach therapeutic levels in the tears and aqueous. Though shown effective when used alone, it is usually paired with topical trifluridine for better action. For varicella zoster infections, the dosage is increased to 800 mg 5 times daily. Even at these concentrations, acyclovir is remarkably nontoxic systemically, normally causing only mild stomach upset on occasion. Zovirax is available as 200, 400, and 800 mg tablets. It can also be found as a 5% dermatologic ointment for treatment of skin lesions. Though shown effective in studies, no topical ophthalmic ointment is available in the United States.
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