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in other cases, diagnosis of hsv ocular recurrence may warrant an abbreviated course of empiric therapy. acyclovir or valacyclovir are more effective than acyclovir and valacyclovir. studies suggest there is little difference between the two.243, 244 initiation of oral antiviral therapy may be more appropriate when a new ocular or mucocutaneous lesion is seen in hsv-seropositive patients who have symptoms of recurrent infection despite an inadequate response to a one- to two-week course of topical antiviral agents. if there is recurrence of ocular infection or new ocular or mucosal lesion during the course of treatment with topical antiviral agent, the topical antiviral agent should be re-instituted for two weeks, followed by a 4-week course of either a 10 mg/kg per day oral antiviral or valganciclovir solution, with possible addition of a three-to six-month course of acyclovir or valacyclovir. this abbreviated course is considered off label. it is recommended in cases of mucosal lesion, but is considered off label for ocular lesions. there is no definitive evidence that this approach increases the risk of viral resistance to topical antivirals, and there are concerns that the combination of topical and systemic antiviral therapies increases the risk of toxicity. resistance has been reported in cases of topical treatment with acyclovir and valganciclovir alone and combined in a study of patients with hsv-related recurrent stromal keratitis. the data on systemic therapy is consistent with the data observed with topical monotherapy: in hsv-seropositive patients with ocular lesions, a 10 mg/kg per day of oral valganciclovir or acyclovir is more effective than acyclovir alone.
In post-traumatic HSV stromal keratitis, oral antiviral agents may be useful in the treatment of HSV stromal keratitis. However, topical acyclovir ointment is by far the better treatment, as oral antiviral agents are not FDA approved for the treatment of this condition.
There is no evidence for or against the use of oral antiviral agents in the treatment or prevention of herpes zoster. As a corollary, there is no strong evidence to recommend the use of any particular antiviral agent in the treatment or prevention of herpes zoster.
Oral antiviral agents have little direct effect on the severity or location of ocular dry eye syndrome. At best, oral antiviral agents may serve as an adjunct for patients with clinically severe dry eye who are either intolerant or unwilling to use topical artificial tears.
detectives and agents were assigned to the task because of their extensive experience dealing with such problems. during his childhood in tarrytown, carroll had been a student in a new york city school for delinquent boys. according to the juvenile probation officer who later filed a report on carroll, he had many convictions, including those for armed robbery, theft, receiving stolen goods, grand larceny, passing forged checks, petit larceny, forgery, and petty larceny. in the case that the juvenile probation officer reported on carroll, he had been arrested at a new york city pool hall on a warrant for passing a forged check, and had been found to be carrying a concealed weapon. two policemen found him loitering in the vicinity of the pool hall.
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