From the Guidelines
Herpes Simplex Virus (HSV) infection of the eyelid without corneal involvement (keratitis) is typically a self-limited condition that can be diagnosed based on clinical signs and symptoms.
Diagnostic Approach
- The diagnostic approach for HSV infection of the eyelid without keratitis involves identifying clinical signs such as:
- Unilateral or bilateral bulbar conjunctival injection
- Watery discharge
- Mild follicular reaction of conjunctiva
- Palpable preauricular node
- Vesicular rash or ulceration of eyelids 1
- A thorough medical history is also essential to identify potential predisposing factors, such as prior infection with HSV, stress, other acute viral or febrile illnesses, ultraviolet exposure, surgery, or trauma 1
Treatment and Management
- Treatment is usually instigated upon high suspicion or concomitant corneal involvement, and may include topical antiviral options such as ganciclovir 0.15% gel or trifluridine 1% solution, as well as oral antivirals like acyclovir, valacyclovir, or famciclovir 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
Diagnostic Approach for Herpes Simplex Virus (HSV) Infection of the Eyelid
The diagnostic approach for HSV infection of the eyelid without corneal involvement (keratitis) involves several key considerations:
- Clinical manifestations, such as erosions of the intermarginal portion of the lid, skin ulcers located at the lid margin, and mild swelling and tenderness on palpation 2
- Laboratory confirmation using techniques like indirect immunofluorescence 2
- Cytologic examination of a scraping obtained from an eyelid pustule vesicle to reveal multinucleated keratinocytes, diagnostic of a herpetic infection 3
- Virologic studies to prove that herpes simplex virus type 1 is the causal agent 3
Treatment and Management
Treatment for HSV infection of the eyelid without corneal involvement may include:
- Supportive or topical acyclovir ointment treatment to control the disease 4
- Combination of antibiotic and virustatic ointments 2
- Topical antiviral therapy, such as trifluridine 1% solution or ganciclovir 0.15% ophthalmic gel, to enable resolution of HSV epithelial keratitis that may arise during oral acyclovir treatment 5
Key Considerations
It is essential to note that:
- Recurrent ocular herpes was generally thought to be characterized by corneal involvement, but cases of recurrent HSV blepharitis without corneal involvement have been reported 4
- Oral antiviral therapy alone may not adequately prevent progression of infectious ocular HSV blepharoconjunctivitis, and topical antiviral therapy may be necessary 5