Herpes simplex virus ocular infections.
Herpes simplex ocular infection is the leading cause of infectious corneal blindness in the United States and presents a frequent challenge to ophthalmologists. The epithelial infections are usually readily controlled with trifluridine or vidarabine, but clinical resistance may be emerging, and host toxicity remains a problem in chronic cases. Acyclovir offers an alternative, and the oral form appears to be an effective antiviral prophylaxis in stromal keratitis and post-penetrating keratoplasty, as well as a treatment for epithelial infections in patients where administration of topical therapy is difficult. Valacyclovir and perhaps famciclovir may provide similar efficacy as acyclovir at reduced doses. In addition, better control of inflammation with potent steroids used at the appropriate phases of HSV infection can minimize scarring and vascularization. Newer agents attempt to provide more specific therapy for both the infectious and inflammatory components of HSV ocular infections.
Lee
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Instructor of Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.