Ophthalmic Antivirals
Key Points
- Trifluridine is a primary topical antiviral for herpes simplex ocular infections.
- Systemic absorption is minimal, so most adverse effects are local ocular effects.
- If there is no improvement after about 7 days, reassessment and alternate therapy should be considered.
- Continuous use beyond about 21 days should be avoided due to ocular toxicity risk.
- Storage/handling and biohazard-style disposal teaching are essential safety components.
Class Overview
Ocular antivirals suppress local viral replication in herpes-related keratoconjunctival disease. Topical therapy aims to heal epithelial defects while limiting progression and complications.
Prototype Dosing
| Drug | Typical Adult Ophthalmic Dosing | Key Indications |
|---|---|---|
| Trifluridine 1% | 1 drop every 2 hours while awake (max 9 drops/day) until complete re-epithelialization, then 1 drop every 4 hours while awake for 7 more days (minimum 5 drops/day) | Primary keratoconjunctivitis and recurrent epithelial keratitis due to HSV types 1 and 2 |
Adverse Effects and Contraindications
- Mild transient burning/stinging
- Palpebral conjunctival edema
- Hyperemia, epithelial keratopathy, keratitis sicca
- Increased IOP or ocular-toxicity patterns with prolonged exposure
- Rare retinal-detachment warning symptoms may occur
Contraindication is primarily hypersensitivity to active/inactive ingredients.
Nursing Assessment and Interventions
- Assess decline in conjunctival erythema and corneal-healing progression.
- If no improvement by day 7 or re-epithelialization remains incomplete, escalate for treatment reassessment.
- Avoid continuous therapy beyond 21 days unless specialist-directed.
- Screen for retinal-detachment cues (floaters, flashes, curtain-like shadow) and escalate immediately if present.
- Use contagious-infection precautions in care interactions.
Client Education
- Store refrigerated (about 36 F to 48 F) and bring solution to room temperature before instillation.
- Wash hands and exposed skin thoroughly after handling medication.
- Use proper no-touch instillation and disposal technique for container/drug remnants.
- Report worsening vision, flashes/floaters, or persistent severe irritation urgently.
- Do not assume HSV eradication after symptom improvement; recurrence is possible.
Related Concepts
- ophthalmic-medication-administration - Instillation, contamination prevention, and route safety.
- antiviral-medications - Broader antiviral class principles.
- ophthalmic-antibiotics - Ocular infection differential and parallel teaching points.
- eye-assessment-visual-acuity-and-common-abnormalities - Vision-change red-flag triage.