Correspondence

Trifluridine for Herpes Zoster

N Engl J Med 1994; 331:481-482August 18, 1994

Article

To the Editor:

In the Images in Clinical Medicine section (March 31 issue),1 Rosencrance presents an excellent clinical photograph of herpes zoster involving the right trigeminal nerve. He mentions that the patient was treated with intravenous acyclovir, as well as trifluridine and sulfacetamide-prednisolone eyedrops. I am aware of no study supporting the use of trifluridine for the treatment of herpes zoster keratitis2. Topical trifluridine is extremely expensive, causes side effects such as superficial punctate keratopathy and epithelial defects, and is indicated only for the treatment of external eye infections caused by herpes simplex virus. Although herpes zoster uveitis and keratitis may respond to topical steroids, the need for sulfacetamide (presumably to prevent superinfection by sulfa-sensitive bacteria) is also questionable in this case.

David J. Harris, Jr., M.D.
University of Tennessee Medical Center, Knoxville, TN 37920

2 References

1. 1

   Rosencrance G. Herpes zoster. N Engl J Med 1994;330:906-906
   Full Text | Web of Science | Medline

2. 2

   Karbassi M, Raizman MB, Schuman JS. Herpes zoster ophthalmicus. Surv Ophthalmol 1992;36:395-410
   CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Rosencrance and a colleague, Dr. Frances, reply:

To the Editor: Dr. Harris is correct in stating that there is no study supporting the use of trifluridine eyedrops for the treatment of herpes zoster keratitis. However, to classify trifluridine as extremely expensive is misleading. The cost at our institution for a 7.5-ml bottle is $26.50. During the acute phase of herpes zoster ophthalmicus, topical steroids are clearly indicated and effective in suppressing the inflammatory response1. They are also effective in reducing corneal infiltrates and keratic precipitates2. Since the risk of superinfection is present, we think simultaneous topical antibiotics are indicated.

Greg Rosencrance, M.D.
Charles Frances, M.D.
West Virginia University, Charleston, WV 25304-1299

2 References

1. 1

   Mader TH, Stulting RD. Viral keratitis. Infect Dis Clin North Am 1992;6:831-849
   Web of Science | Medline

2. 2

   Bergaust B, Westby RK. Zoster ophthalmicus: local treatment with cortisone. Acta Ophthalmol (Copenh) 1967;45:787-793
   CrossRef | Web of Science | Medline