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Antiviral — Topical (Herpetic Keratoconjunctivitis) Pregnancy: There is insufficient experience regarding administration during pregnancy or lactation to evaluate the safety of this product during these periods. Teratogenicity and an effect on fertility have been observed in animal studies with orally or intravenously administered ganciclovir, and ganciclovir has shown potential genotoxicity with a low safety margin. Administration during pregnancy or lactation is therefore not recommended, except in the absence of an alternative treatment. For women of childbearing age, contraceptive measures should be used during treatment and for up to six months thereafter. Because of the genotoxic effect in animal studies, men taking this product are advised to use local contraceptive measures (for example condoms) during treatment and for up to three months thereafter.

Ganciclovir Ophthalmic Gel 0.15%

Brand names: Virgan

Ganciclovir 0.15% ophthalmic gel is a topical antiviral applied to the eye for acute herpetic keratitis caused by herpes simplex virus.

Adult dose

Dose: Topical ocular antiviral treatment (this page: herpetic keratoconjunctivitis) — instil one drop of gel in the inferior conjunctival sac of the eye to be treated
Route: Topical ophthalmic — ocular instillation into the inferior conjunctival sac of the affected eye. Virgan is a 0.15% w/w eye gel
Frequency: 5 times a day until complete corneal re-epithelialisation, then 3 instillations a day for 7 days after healing
Max: No milligram or drop-count ceiling is given. The only limit the SPC states is duration: the treatment does not usually exceed 21 days
§4.2 verbatim: 'Instil one drop of gel in the inferior conjunctival sac of the eye to be treated, 5 times a day until complete corneal re-epithelialisation. Then 3 instillations a day for 7 days after healing. The treatment does not usually exceed 21 days.' Elderly: 'The dosage in the elderly is the same as in adults' — no adjustment is needed; patients up to the age of 85 years were treated in clinical trials with no specific health concerns observed. SCOPE LIMITS STATED IN THE SPC (§4.4): this medicinal product is NOT indicated in the treatment of cytomegalovirus (CMV) retinal infections, and efficacy in other viral types of keratoconjunctivitis has not been demonstrated; no specific clinical studies were performed in immunodepressed subjects. The SPC's §4.1 therapeutic-indication text was not captured in this source bundle — the indication wording above follows this page's own identity and is consistent with the §4.4 statement that efficacy in OTHER viral keratoconjunctivitis is not demonstrated. ADMINISTRATION: if more than one topical ophthalmic drug is used, administer the drugs at least fifteen minutes apart and instil this gel LAST. Remove contact lenses prior to application and wait at least 15 minutes before reinsertion — the product contains 0.375 mg benzalkonium chloride in each 5 g tube, which may cause eye irritation (especially in dry eyes or corneal disorders), may be absorbed by soft contact lenses and may change their colour.

Paediatric dose

Dose: Not recommended — use of the medicinal product in children under 18 years is not recommended since no specific studies have been conducted
Route: N/A — no paediatric use is recommended in this SPC
Frequency: N/A
Max: Not established
§4.2 verbatim: 'Use in children: Use of the medicinal product in children under 18 years is not recommended since no specific studies have been conducted.' No paediatric figure is published here, and the adult regimen has NOT been carried across.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to ganciclovir or aciclovir, or to any of the excipients listed in section 6.1

Side effects

  • Very common: transient burning or stinging sensations
  • Very common: eye irritation
  • Very common: blurred vision
  • Common: superficial punctate keratitis
  • Common: conjunctival hyperaemia
  • The reactions above are those reported across four clinical trials with this eye gel (three phase IIB trials and one phase III trial)

Monitoring

  • Treat until complete corneal re-epithelialisation is achieved, then continue three times a day for 7 days after healing; treatment does not usually exceed 21 days
  • This product is not indicated for cytomegalovirus (CMV) retinal infection, and efficacy in other viral types of keratoconjunctivitis has not been demonstrated — reconsider the diagnosis rather than extending treatment if there is no response
  • No specific clinical studies were performed in immunodepressed subjects
  • Contact lenses: remove before application and wait at least 15 minutes before reinsertion (benzalkonium chloride may be absorbed by soft lenses and may change their colour)
  • If more than one topical ophthalmic drug is used, administer at least fifteen minutes apart and instil this gel last
  • Women of childbearing age should use contraceptive measures during treatment and for up to six months thereafter; men are advised to use local contraceptive measures during treatment and for up to three months thereafter

Clinical monograph

How it works

Ganciclovir is phosphorylated within virus-infected cells and the active triphosphate inhibits viral DNA polymerase, halting replication of herpes simplex virus on the ocular surface; the gel vehicle prolongs corneal contact.

Prescribing in practice

  • Treatment should continue for a short period after the corneal epithelium has healed, and topical corticosteroids should be avoided in active epithelial (dendritic) herpetic keratitis as they can worsen the infection.
  • Soft contact lenses should not be worn during treatment of active herpetic keratitis.
  • Transient blurring and mild local irritation or stinging after application are common.

Monitoring

Monitoring is by serial slit-lamp examination to confirm healing of the dendritic ulcer and to detect any progression or stromal involvement requiring specialist input.

Counselling the patient

  • Vision may blur for a short time after applying the gel, so wait before driving.
  • Do not wear contact lenses until the infection has cleared and you are advised it is safe.
  • Keep using it for the full course, including the days after the eye feels better, and return promptly if vision worsens.

Evidence & guidelines

Topical ganciclovir gel is an established treatment for herpes simplex epithelial keratitis and is widely used as an alternative to aciclovir eye ointment in ophthalmic practice.

Reference: RCOphth Guidelines; SPC Virgan; Herpetic Keratitis Treatment Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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