A 78-year-old woman complains of a new rash on the left side of her face. The dermatomal distribution is consistent with herpes zoster ophthalmicus (HZO). You should:
Prescribe the oral antiviral acyclovir 800 mg 5 times/d for 7 days.
+Prescribe oral antiviral acyclovir 800 mg 5 times/d for 7 days, and desipramine 25 mg, taper up to 75 mg at bedtime for several weeks.
+Treat with oral antiviral famciclovir 500 mg tid, valacyclovir 1 g tid, or acyclovir 800 mg 5 times/d for 7 days; nortriptyline or desipramine 25 mg, taper up to 75 mg at bedtime for several weeks (if needed) to inhibit acute and prolonged postherpetic neuralgia.
+Document all external lesions and ocular findings. Proceed with treatment protocol for acute herpes zoster ophthalmicus. Prescribe oral antiviral (famciclovir 500 mg tid, valacyclovir 1 g tid, or acyclovir 800 mg 5 times/d for 7 days); prescribe tricyclic antidepressant (nortriptyline or desipramine 25 mg, taper up to 75 mg at bedtime for several weeks if needed) to inhibit acute and prolonged postherpetic neuralgia. Prescribe additional topical steroids, antibiotics, dilators, antivirals, and glaucoma medications as necessary for keratitis, iritis, or glaucoma. Advise the patient of disease prognosis, and prepare the patient for the possibility of postherpetic neuralgia. Consult an ophthalmologist.
+Document all external lesions and ocular findings. Proceed with treatment protocol for acute herpes zoster ophthalmicus. Prescribe oral antiviral (famciclovir 500 mg tid, valacyclovir 1 g tid, or acyclovir 800 mg 5 times/d for 7 days); prescribe tricyclic antidepressant (nortriptyline or desipramine 25 mg, taper up to 75 mg at bedtime for several weeks if needed) to inhibit acute and prolonged postherpetic neuralgia. Prescribe additional topical steroids, antibiotics, dilators, antivirals, and glaucoma medications as necessary for keratitis, iritis, or glaucoma. Advise the patient of the disease prognosis, and prepare the patient for the possibility of postherpetic neuralgia. Set up an appointment with a neurologist.
Prescribe oral antiviral (famciclovir 500 mg tid, valacyclovir 1 g tid, or acyclovir 800 mg 5 times/d for 7 days); prescribe tricyclic antidepressant (nortriptyline or desipramine 25 mg, taper up to 75 mg at bedtime for several weeks if needed) to inhibit acute and prolonged postherpetic neuralgia. Prescribe additional topical steroids, antibiotics, dilators, antivirals, and glaucoma medications as necessary for keratitis, iritis, or glaucoma. Advise the patient of disease prognosis, and prepare the patient for the possibility of postherpetic neuralgia. Consult an ophthalmologist.