What is the primary first-line treatment for herpes keratitis?

The primary first-line treatment for herpes keratitis is oral acyclovir. This antiviral medication is effective in managing infections caused by the herpes simplex virus, which is responsible for herpes keratitis. The condition typically presents with symptoms such as eye pain, redness, tearing, and possible vision changes.

Acyclovir works by inhibiting viral DNA synthesis, effectively reducing the severity and duration of herpes simplex virus infections. In cases of herpes keratitis, oral acyclovir is preferred because it not only aids in healing of the corneal epithelium but also helps to prevent recurrence of the infection.

Topical steroids are often contraindicated in herpes keratitis because they can potentially worsen the infection by suppressing the local immune response. Fluconazole is an antifungal medication and is not used for viral infections, and IV acyclovir is typically reserved for more severe cases, such as herpes simplex encephalitis or when the infection cannot be managed with oral medications. Thus, for typical cases of herpes keratitis, oral acyclovir stands out as the most appropriate and effective first-line treatment.