What are the symptoms and treatment options for Herpes Simplex Virus (HSV) eye infection?

From the Guidelines

Herpes Simplex Virus (HSV) eye infection typically presents with symptoms such as bulbar conjunctival injection, watery discharge, mild follicular reaction of conjunctiva, and may have palpable preauricular node, and can be treated with topical or oral antiviral medications.

Symptoms of HSV Eye Infection

• Unilateral or bilateral bulbar conjunctival injection
• Watery discharge
• Mild follicular reaction of conjunctiva
• Palpable preauricular node
• Distinctive signs: vesicular rash or ulceration of eyelids, pleomorphic or excavated dendritic epithelial keratitis of cornea

Treatment Options for HSV Eye Infection

• Topical options:
  • Ganciclovir 0.15% gel used three to five times per day 1
  • Trifluridine 1% solution five to eight times per day 1
• Oral treatments:
  • Acyclovir (200 to 400 mg five times a day) 1
  • Valacyclovir (500 mg two or three times a day) 1
  • Famciclovir (250 mg twice a day) 1
• Topical corticosteroids should be avoided as they potentiate HSV epithelial infections 1
• Lower doses of oral antivirals are considered for long-term prophylaxis against recurrent HSV conjunctivitis and keratitis 1

Follow-up and Special Considerations

• Patients should have a follow-up visit within 1 week of treatment, consisting of an interval history, visual acuity measurement, and slit-lamp biomicroscopy 1
• Neonates require prompt consultation with the pediatrician or primary care physician, as systemic HSV infection is a life-threatening condition 1

From the Research

Symptoms of Herpes Simplex Virus (HSV) Eye Infection

• The symptoms of HSV eye infection can range from mild epithelial involvement to more severe stromal or endothelial disease 2
• Recurrent episodes of HSV eye infection can manifest in different clinical patterns, including inflammation, scarring, and vision impairment 2, 3
• The severity and frequency of recurrences vary among individuals, and severe cases can result in vision impairment or even blindness in extreme cases 2, 4

Treatment Options for HSV Eye Infection

• Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis and treatment of HSV eye infection 2, 5
• Corticosteroids, interferons, and other newer therapies may also be appropriate depending on the disease presentation 3, 6
• The management of HSV eye infection involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization 2
• Newer antivirals may provide easier compliance with improved bioavailability, efficacy, dosage, and tolerability, and further research is needed to prevent latency of HSV, decrease recurrences, and more effectively treat necrotizing keratitis associated with HSV 6, 5