Pathogenesis and management of herpes simplex virus keratitis

Abstract

Herpes simplex keratitis (HSK) remains a common cause of unilateral corneal disease. Despite intense research over three decades, the mainstay of therapy continues to be topical and, more recently, systemic acyclovir plus topical corticosteroid in some cases. There is increasing recognition that HSK after keratoplasty can occur not only as a result of recurrence in patients with HSK, but also in patients with other primary diagnoses as a result of activation of HSV in the host, or by transmission of virus in the donor tissue.

Corneal ulcer? Think beyond only a bacterial etiology

“…1 In addition, in an under developed country like ours where bacterial and fungal keratitis are far more common, a viral etiology for keratitis is generally not thought of initially, which delays the initiation of timely appropriate treatment often resulting in permanent damage.…”

“…This was treated with systemic and topical antivirals. 1,3,5 Later with the development of stromal keratitis the patient also had an associated anterior uveitis and raised IOP. Both of which are only seen with stromal keratitis and never with just a dendritic ulcer.…”

“…Also he later developed stromal keratitis which is rarely seen in primary infection. 1,7 On arrival to this center, only the corneal epithelium was involved, which is also the most common ocular presentation of HSV, 8 manifesting as a dendritic ulcer. This was treated with systemic and topical antivirals.…”

“…4 This was managed with the addition of topical steroids as well as antiglaucoma medicines because it has been shown that the management of increased IOP occurring secondary to HSV kerato-uveitis is directed initially at halting the viral disease, followed by treatment with corticosteroids which are necessary to control the inflammatory aspects of the disease and reduce the IOP by suppressing the trabeculitis. 1,4 This also is the recommended line of management as far as endothelitis is concerned. Additional antiglaucoma medications are sometimes needed to control the ocular hypertension.…”

Current Concepts in the Management of Herpes Simplex Anterior Segment Eye Disease

“…This attribute allows neuronal viral recurrences manifesting as various forms of peripheral herpetic disease. Nucleocapsids located in the ganglion are carried by anterograde axonal transport along microtubules to axon terminals where the egress of enveloped infectious particles takes place, allowing for trans-synaptic and further inter-cellular spread [1,4].…”