Treat Viral EKC with ZIRGAN

In 2009 I blogged about Treating EKC with Betadine. At the time it was an interesting topic because there was basically no way to treat viral keratitis at all. I didn't use it very often, however, because patients just complained too much about the stinging and burning of the betadine, even after lavage (washing it out). Basically the treatment was so painful for some that it kind of turned me off from using it. Now, however, I am treating viral EKC ("epidemic kerato-conjunctivitis" or viral "pink eye") with ZIRGAN. Zirgan is ophthalmic gancyclovir (anti-viral), designed and marketed for the treatment of HSV (herpes simplex virus) keratitis, and it has quickly become the gold standard. It absolutely works, and is infinitely better at treating HSV than it's predecessor Viroptic. I read a blurb in an ophthalmology trade publication about possibly treating EKC with Zirgan as an "off-label" use and I tried it on a few patients with resounding success. It absolutely works for this, and so now I do it routinely. The big problem is that it is expensive! a 5 gram tube (because it's a "gel" in a tube, not a bottle of liquid) still runs between $225-275 last time I called around. That's pretty high for a benign condition that is self-resolving, but I tell patients that they have to weigh how miserable they are vs how much they are willing to spend. It's not dangerous to not-treat EKC...it's only REALLY ANNOYING.