Welcome to Review of Optometry's Practice Pearl of the Week series. Optometrist Paul Karpecki will provide you invaluable clinical information and management strategies for a host of ocular conditions—from dry eye and corneal infection to retinal artery occlusion and neuro-ophthalmic disease.

Anti-viral medications are essential in the treatment of herpes zoster and herpes simplex type-1. As a tip, you should memorize proper dosing for a case of herpes zoster and then simply use half the respective dose to treat active herpes simplex virus (or approximately one-third of the dose for prophylactic treatments).

• Oral dosing for herpes zoster is as follows:
  - 1,000mg of valacyclovir t.i.d., or
  - 800mg of acyclovir five times a day.

• Oral dosing for herpes simplex is as follows:
  - 500mg of valacyclovir t.i.d., or
  - 400mg of acyclovir five times a day.

• For prophylactic of HSV (to prevent a recurrence of stromal keratitis or prior to surgery):
  - 1,000mg of valacyclovir q.d., or
  - 800mg of acyclovir b.i.d.

Also, keep in mind that topical antivirals, such as Zirgan (ganciclovir ophthalmic gel, Bausch + Lomb), should also be prescribed in cases of epithelial herpes simplex keratitis (e.g., dendritic keratitis). The dosing for Zirgan is five times a day until the dendritic ulcer heals, and then t.i.d. for one additional week.

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