Bilateral herpetic keratoconjunctivitis.
OBJECTIVE
To review the clinical characteristics and visual outcomes of patients with bilateral herpetic keratitis.


METHODS
Retrospective, noncomparative, observational case series.


METHODS
A retrospective review of medical records of 544 patients with herpes simplex virus (HSV) eye disease treated between January 1996 and September 2001 was performed at the Department of Ophthalmology, University of Minnesota. Seven patients (1.3%) with bilateral herpetic keratoconjunctivitis were identified.


RESULTS
In these seven patients, the age at the initial onset of corneal disease ranged from 7 weeks to 46 years, with a median of 18 years and a mean of 19.3 years. Five patients had systemic atopy, and two patients had severe ocular rosacea. Systemic immune disorders were noted in two patients. Recurrent blepharoconjunctivitis was noted in 8 eyes (57%), epithelial keratitis in 12 eyes (85.7%), stromal keratitis in 9 eyes (64.3%), necrotizing stromal keratitis in 5 eyes (35.7%), and progressive endotheliitis in 2 eyes (14.2%). Corneal complications included opacification, neovascularization, and corneal thinning or perforation. Penetrating keratoplasty was performed in 1 eye, in which endophthalmitis subsequently developed and which required enucleation. Four patients with continued use of oral antiviral prophylaxis (acyclovir 400 mg twice daily) since September 1999 showed significant decreases in recurrence. The average remission in these four patients was 1.7 years. The visual acuity at the last follow-up was 20/40 or worse in 6 eyes (42.8%).


CONCLUSIONS
In contrast to unilateral HSV keratitis, our patients with bilateral herpetic corneal infections had underlying atopy or immune deviations and evinced more protracted clinical courses. Long-term prophylactic antiviral treatment has reduced the incidence of recurrence in this group of patients.
Souza
Paula Márcia F
PM
Department of Ophthalmology, University of Minnesota, 516 Delaware Street SE, Minneapolis, MN 55455, USA.
Holland
Edward J
EJ
Huang
Andrew J W
AJ
D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000998:Antiviral Agents / Q000627:therapeutic use; D002675:Child, Preschool; D016510:Corneal Neovascularization / Q000209:etiology; D003318:Corneal Opacity / Q000209:etiology; D003319:Corneal Stroma / Q000473:pathology / Q000821:virology; D019573:Epithelium, Corneal / Q000473:pathology / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D016849:Keratitis, Herpetic / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D007637:Keratoconjunctivitis / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014792:Visual Acuity
D000998:Antiviral Agents; D000212:Acyclovir