Update on Herpes simplex keratitis management

Abstract

Herpes simplex keratitis (HSK) is a common, potentially blinding condition characterised by recurrent infections of the cornea, seen by both general ophthalmologists and corneal specialists. Successful treatment of recurrences reduces disease duration, prevents progressive corneal scaring leading to vision loss and reduces risk of further recurrences. In this review we discuss the relative advantages of the diagnostic laboratory investigations including polymerase chain reaction, viral culture and fluorescence-based immunohistochemistry. We review treatment strategies in selected aspects of HSK and discuss the management options in cases not responding to treatment.

Fig. 1. Dendritic corneal ulceration in recurrent epithelial HSV.

Fluorescein staining of an epithelial recurrence in a cornea with scarring and vascularisation resulting from multiple stromal recurrences.

Fig. 2. Geographic ulceration in recurrent epithelial HSV.

Rose Bengal corneal staining in a patient with atopic keratoconjunctivitis before (left) and following (right) treatment with topical ACV for 7 days.

Fig. 3. Corneal oedema in HSV endotheliitis.

The same diagnosis had been confirmed in the contralateral eye 5 years earlier.

Fig. 4. Management of persistent ulceration in HSV keratitis.

Laboratory confirmation or exclusion of active viral infection is critical in this suggested approach in the management of persistent corneal ulceration.