Antiviral — Topical (Herpetic Keratoconjunctivitis) Pregnancy: Topical use — minimal systemic absorption; systemic ganciclovir is teratogenic; topical considered safer

Ganciclovir Ophthalmic Gel 0.15%

Brand names: Virgan

Adult dose

Dose: 1 drop five times daily until healing; then 1 drop three times daily for 7 days

Route: Topical ophthalmic

Frequency: Five times daily (acute); three times daily (maintenance for 7 days after healing)

Max: 5 drops per day (acute phase)

Used for herpetic keratoconjunctivitis (HSV-1, HSV-2, VZV). Gel formulation — sustained contact time. Alternative to aciclovir eye ointment. Can be used in patients where aciclovir resistance is suspected (different mechanism).

Paediatric dose

Route: Topical

Frequency: Five times daily

Max: Same as adult

Paediatric herpetic keratoconjunctivitis — seek specialist guidance; limited paediatric data

Dose adjustments

Renal

No adjustment — topical only; negligible systemic absorption

Hepatic

No adjustment

Clinical pearls

Ganciclovir gel vs aciclovir ointment: both are effective for HSV keratitis; ganciclovir gel (drops) may be preferred for patient convenience (drops vs ointment application); equivalent efficacy in clinical trials
CMV retinitis treatment: topical ganciclovir gel DOES NOT reach the retina — CMV retinitis (in immunocompromised patients, particularly HIV) requires either IV ganciclovir, oral valganciclovir, or intravitreal ganciclovir implant; never use topical gel for posterior segment infections
Mechanism: ganciclovir is phosphorylated by viral (not host cell) thymidine kinase — selective toxicity to herpesvirus-infected cells; aciclovir shares this mechanism (both are guanosine analogues)
Aciclovir resistance: rare; mediated by thymidine kinase mutations; ganciclovir cross-resistance usually occurs (same enzyme); foster resistance — refer to virology/ophthalmology specialist
Immunocompromised patients with herpetic keratitis: systemic antiviral (oral aciclovir/valaciclovir) should be co-prescribed in addition to topical treatment

Contraindications

Hypersensitivity to ganciclovir or valganciclovir
Do not use in CMV retinitis — IV ganciclovir or intravitreal injection required; topical gel does not reach posterior segment

Side effects

Transient blurring on instillation
Ocular burning
Superficial keratitis (rare)

Interactions

No clinically significant interactions with topical ophthalmic use

Monitoring

Fluorescein healing assessment at day 5–7
Visual acuity

Reference: BNFc; BNF 90; RCOphth Guidelines; SPC Virgan; Herpetic Keratitis Treatment Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways