Oral Acyclovir for Herpes Simplex Blepharoconjunctivitis in Children

We read the article by Liu et al on the clinical characteristics, treatment, and outcomes of pediatric herpes simplex virus (HSV) infections of the anterior segment with great interest. The researchers found that of the 53 patients (57 eyes), 18 eyes had HSV blepharoconjunctivitis (HBC) only. Eighty percent of patients had recurrent disease. Thirty-six percent of patients receiving long-term oral acyclovir had recurrent HSV. The authors suggested that physicians caring for children with recurrent unilateral blepharoconjunctivitis, keratitis, or both should consider the diagnosis of HSV infection and treat patients with oral acyclovir. The authors reported that long-term, systemic use of acyclovir was not associated with any significant safety issues, and they adjusted the dosage of acyclovir as the child grows to maintain adequate suppressive levels. We have a few concerns we believe are pertinent when treating these HBC patients with oral acyclovir.