title: A prospective study of the clinical characteristics of patients with herpes simplex and varicella zoster keratitis, presenting to a New Zealand emergency eye clinic.
abstract: OBJECTIVE
  To identify the demographic and clinical associations of patients presenting with herpetic keratitis in New Zealand compared with presentations of presumed microbial keratitis.
  
  
  METHODS
  A prospective, 6-month, observational case series of presumed microbial keratitis (including marginal keratitis), specifically identifying all cases of herpes simplex and varicella zoster keratitis attending an emergency eye clinic was conducted. Main outcome measures included demographics, presenting signs and symptoms, and medical, ocular, and drug history.
  
  
  RESULTS
  A total of 140 cases of herpetic keratitis were identified, which comprised 125 cases of herpes simplex virus (89%) and 15 cases of varicella zoster virus (11%). Herpes simplex keratitis was associated with a history of keratitis (n = 58, phi = 0.24, P < 0.0001), Maori ethnicity (n = 27, phi = 0.26, P < 0.0001), respiratory disease (n = 18, phi = 0.14, P = 0.009), corticosteroid use (n = 23, phi = 0.22, P < 0.0001), and cardiovascular disease (CVD) (n = 10, phi = 0.11, P = 0.03). Inverse association was observed between herpes simplex keratitis and ocular surface disease (n = 8, phi = -0.16, P < 0.002) and Asian ethnicity (n = 4, phi = -0.11, P = 0.04). Varicella zoster keratitis was associated with CVD (n = 3, phi = 0.15, P = 0.03).
  
  
  CONCLUSIONS
  Patients with asthma, CVD, on long-term corticosteroid inhalers or creams, or of Maori ethnicity need particular assessment to investigate herpes simplex as a possible cause of keratitis. Clinicians prescribing inhaled corticosteroids or topical corticosteroid creams should be aware of possible association with herpes simplex keratitis.
authors.affiliation: Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Elissa M
authors.initials: EM
authors.lastname: McDonald
authors.forename: Dipika V
authors.initials: DV
authors.lastname: Patel
authors.forename: Charles N J
authors.initials: CN
authors.lastname: McGhee
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D001249:Asthma / Q000150:complications; D002318:Cardiovascular Diseases / Q000150:complications; D005260:Female; D006563:Herpes Zoster Ophthalmicus / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D006801:Humans; D007634:Keratitis / Q000821:virology*; D016849:Keratitis, Herpetic / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones