How Do Ophthalmic Antivirals Work?

Ophthalmic antivirals are medications for treating viral eye infections and the resultant inflammation. Ophthalmic antiviral medications include drugs that inhibit viral replication, and fluorinated corticosteroids that inhibit inflammation and relieve symptoms. Corticosteroids are fluorinated to achieve better absorption into the eye.

Ophthalmic antiviral drugs penetrate the virus-infected cell, get incorporated into the DNA and prevent its replication. Each antiviral medication works on different enzymes that the virus requires to synthesize DNA and replicate itself. Corticosteroids relieve symptoms by inhibiting the infected eye’s inflammatory responses such as:

• Tissue swelling due to fluid collection (edema)
• Migration of immune cells (leukocytes) to the inflammation site
• Blood vessel (capillary) dilation
• Scar formation

Ophthalmic antiviral medications are solutions, suspensions, gels or ointments topically administered in the eye. Ophthalmic antivirals are used to treat the following eye conditions:

• Acute herpetic keratitis: Inflammation of cornea from infection with herpes simplex virus (HSV-1 and HSV-2).
• Herpetic keratoconjunctivitis: Inflammation from herpes simplex virus infection in both cornea and conjunctiva, the clear membrane that covers the eye and the inner surface or the eyelids.
• Ocular inflammation: Eye inflammation resulting from HSV infection.

Side effects of ophthalmic antiviral drugs are mostly ocular and systemic side effects are rare. Corticosteroids have minimal systemic side effects. Side effects of ophthalmic antiviral drugs may include:

• Eye pain, burning and stinging
• Dry eye syndrome (keratitis sicca)
• Punctate keratitis (inflammation of the cornea in a pinpoint pattern)
• Superficial punctate keratopathy (superficial corneal degeneration)
• Epithelial keratopathy (degeneration of epithelial cells in the cornea)
• Corneal edema (stromal edema)
• Follicular conjunctivitis (collection of lymphocytes [follicles] in the conjunctiva)
• Conjunctival hyperemia (dilation of blood vessels in the conjunctiva)
• Blepharitis (inflammation of the eyelids)
• Palpebral edema (edema of eyelids)
• Reduced visual acuity
• Retinal detachment
• Vitreous hemorrhage (bleeding in the gel-like vitreous that fills the eyeball space between the lens and retina)
• Uveitis (inflammation of the uvea, the middle layer of the eye)
• Hyphema (pooling of blood in the anterior eye chamber between the cornea and the lens)
• Spike in pressure inside the eye (intraocular pressure)
• Hypersensitivity reactions such as:
  • Hives (urticaria)
  • Swelling of tissue under the skin (angioedema)

Side effects of ophthalmic antiviral fluorinated corticosteroid may include the following:

• Glaucoma (a disease that damages the optic nerve)
• Cataract
• Superinfection
• Slow wound healing
• Allergic reactions in the eye
• Foreign body sensation
• Eyelid redness (erythema)
• Eyelid edema
• Eye watering and/or discharge
• Eye pain and itching
• Blurred vision
• Visual field defects
• Rash
• Taste perversion (dysgeusia)
• Hypercorticoidism, rare (excessive secretion of hormones by the adrenal cortex)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of some ophthalmic antiviral drugs include:

• Acyclovir ophthalmic (Avaclyr)
• Ganciclovir ophthalmic (Vitracert DSC, Zirgan)
• Trifluridine ophthalmic (Viroptic)
• Fluorometholone (Flarex, FML, FML Forte) - fluorinated corticosteroid