From the Guidelines
Herpes Simplex (HSV) infection of the eye without keratitis is a self-limited acute condition that usually subsides without treatment within 4-7 days, but treatment may be necessary to prevent complications.
Symptoms
- The symptoms of HSV conjunctivitis include:
- Unilateral or bilateral bulbar conjunctival injection
- Watery discharge
- Mild follicular reaction of conjunctiva
- Palpable preauricular node
- Vesicular rash or ulceration of eyelids
- These symptoms can be similar to other types of conjunctivitis, such as varicella zoster virus (VZV) conjunctivitis, but the presence of a vesicular rash or ulceration of the eyelids is more characteristic of HSV conjunctivitis 1.
Treatment Options
- Topical antiviral treatment, such as ganciclovir 0.15% gel or trifluridine 1% solution, may be used to treat HSV conjunctivitis 1.
- Oral antiviral treatment, such as acyclovir, valacyclovir, or famciclovir, may also be used, especially in cases of concomitant corneal involvement or in immunocompromised patients 1.
- Topical corticosteroids should be avoided, as they can potentiate HSV infection 1.
- Patients should have a follow-up visit within 1 week of treatment to monitor for any complications or progression of the disease 1.
From the Research
Symptoms of Herpes Simplex (HSV) Infection of the Eye
- Ocular pain
- Inflammation
- Corneal opacification
- Neovascularization
- Corneal nerve loss
- Neutrophic keratopathy 2
- Variable clinical presentations, not typical for any particular etiology 3
Treatment Options for Herpes Simplex (HSV) Infection of the Eye
- Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis 4
- Antiviral treatment was successful in 72% of patients 3
- Therapies directed towards viral entry into cells, protein synthesis, inflammatory cytokines and vascular endothelial growth factor pathways in animal models represent promising new approaches to the treatment of recurrent HSV keratitis 2
- Current antiviral therapies target viral replication to decrease disease duration, severity and recurrence 2
Important Considerations
- Herpetic corneal infections can present without typical dendritic or geographic ulcers and may be masked by other infections 3
- Real-time PCR is a useful method for rapid and definitive diagnosis 3
- HSV infection should be considered for microbial keratitis without specific risk factors, with negative culture results and poor response to antimicrobial agents 3
- The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization 4