The current management of herpetic eye disease

Abstract

Herpes simplex disciform keratitis is a difficult condition. The general feeling is that it is an immune disease, mediated by the virus, possibly located in the endothelial cells. It is frequently combined with inflammation in the trabecular meshwork and with uveitis. There is some controversy in relation to treatment and it has been suggested that anti-virals will control herpetic disciform keratitis, particularly if the patient has never had steroids previously. The authors of this paper have, in the past, published data which showed that Acyclovir, with corticosteroid, was necessary in the management of disciform keratitis. The data suggested that Acyclovir on its own was not effective. It remained to be answered whether Acyclovir on its own would be effective in patients who never had steroids for any reason previously. This paper demonstrates clearly that it is necessary, irrespective of whether patients have had steroids in the past or not, to combine corticosteroids with Acyclovir in the management of herpetic disciform keratitis. Acyclovir, on its own, is shown to be ineffective. It has also been suggested that Acyclovir is non-toxic. In a general way this is true, but the authors suggest that Acyclovir ointment does produce a punctate keratitis in patients with tear film disease, and that oral Acyclovir is preferable in such patients.

Local delivery of corticosteroids in clinical ophthalmology: A review

“…Endothelial disease typically presents independently of other forms of HSV keratitis and only few studies are available to guide treatment . These compare topical betamethasone with topical acyclovir against topical acyclovir alone (all five times a day) and found that the addition of steroid resulted in a faster response and fewer treatment failures than antiviral alone.…”

Randomised trial of ganciclovir and acyclovir in the treatment of herpes simplex dendritic keratitis: a multicentre study.

“…This can be a problem particularly in patients with tear film disease. 20 Acyclovir, taken in oral form, has also been shown to be effective in the treatment ofherpes simplex keratitis.21…”

A Dual‐Function Electrospun Matrix for the Prevention of Herpes Simplex Virus‐1 Infections after Corneal Transplantation

“…The blended polymer fibers achieved a release that is desirable for treating endothelial keratitis. [ 33 ] The faster drug release of the polymer fibers comprising Tween 80 can be attributed to improved water penetration into deeper fiber layers and accelerated fiber degradation. Furthermore, the complete matrix degradation of the fiber mats occurred over a period of 6–8 weeks (data not shown), which is in good accordance with the literature.…”