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Antifungal — Triazole (Ophthalmic Compounded Preparation)

Voriconazole (Ophthalmic — Fungal Keratitis)

Brand names: VFEND (systemic); Voriconazole 1% eye drops — compounded

This entry concerns voriconazole used ophthalmically as a topical and/or intrastromal/intravitreal antifungal for fungal keratitis and endophthalmitis, prepared as an unlicensed special since it is a broad-spectrum triazole not marketed in a licensed ophthalmic formulation.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Voriconazole inhibits fungal cytochrome P450-dependent 14-alpha-demethylase, blocking ergosterol synthesis and disrupting the fungal cell membrane, with activity against many moulds and yeasts.

Prescribing in practice

  • Ophthalmic voriconazole is an unlicensed extemporaneous preparation, so concentration, sterility and stability must be assured and use should follow specialist corneal/microbiology guidance with culture confirmation where possible.
  • Fungal keratitis often requires combination with another topical antifungal and close specialist review, as monotherapy response can be incomplete.
  • Systemic voriconazole, if co-prescribed for severe infection, carries significant interactions and hepatic and visual adverse effects that warrant separate caution.

Monitoring

Monitor the clinical course of the corneal infiltrate with serial slit-lamp examination and microbiological response under specialist supervision.

Counselling the patient

  • Use exactly as directed by the eye specialist and attend all review appointments, as fungal eye infections need prolonged treatment.
  • Report worsening pain, redness or reduced vision urgently.

Evidence & guidelines

Comparative trials such as the Mycotic Ulcer Treatment Trial informed antifungal choice in fungal keratitis, and management follows specialist microbiology and corneal guidance.

Reference: MUTT Trial (NEJM 2012); RCOphth Microbial Keratitis Guidelines; ECMM/ISHAM Fungal Keratitis Guidelines; SPC VFEND; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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