Is there any benefit from oral vs topical steroids in herpes zoster opthalmicus?

The role of steroids in uncomplicated herpes zoster is limited, but weak evidence suggests they may provide some symptomatic relief. However, oral and topical steroids may have a role in complicated zoster, including cases with ocular involvement/HZO, when used with antiviral therapy, especially if initiated within the first three days. The incidence of direct ocular involvement, encompassing the conjunctiva, uvea, and all layers of the cornea, is high in the absence of antiviral agents. The risk of ocular involvement is signaled by vesicles on the tip or side of the nose and is also a leading cause of acute retinal necrosis.

Topical steroids are particularly relevant for treating keratitis, uveitis, and anterior segment involvement. Howeve...

Agree with above, though I only use even topical steroids if ocular involvement. I have in recent years empirically found Zoster keratitis responds much better to high dose prolonged Acyclovir (a month 800 5Xdaily and then 600 mg TID for a year +) gradually calming down inflammatory keratitis cases that wandered in after a year or two of failure with famciclovir (Famvir), and valacyclovir (Valtrex). Pain relief was remarkable after only 10 days, visual acuity began to slowly improve after 3-4 months. Even in bad cases, 2 years old. This is not at all the standard of care, but has been repeatable in my hands. Apparently, theoretical pharmacology aside, Acyclovir is more potent than the more convenient versions.

I am also willing to restart 3...