Ophthalmologic Manifestations of Herpes Simplex 

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 20, 2009
 

Background

Herpes simplex virus (HSV), a large complex DNA virus, commonly infects the skin and the mucous membranes in the regions of the mouth, genitalia, and eye.

Two antigenically related strains of HSV can be distinguished. Type 1 most commonly is associated with infections of the orofacial area and the ocular surface, while type 2 causes genital disease.[1]

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Pathophysiology

Infection is spread by direct contact of the skin or the mucous membranes to infected secretions. The initial attack is generally self-limited and is often subclinical. However, herpetic disease is recurrent, and a wide range of clinical manifestations can result from an infection with this agent. The most common site of primary infection in humans is the skin and the mucous membrane innervated by the trigeminal nerve. The virus is transported via the nerve axon to its cell body in the sensory ganglion where it persists in a latent state until reactivation. Some indication exists that the human cornea also may harbor latent virus. Recurrent disease is the result of reactivation of this latent virus.

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Epidemiology

Frequency

United States

Of adults in the United States, 50-90% have antibodies to HSV type 1, indicating previous exposure to the virus. Incidence of ocular HSV infection is approximately 0.15%.[2]

Mortality/Morbidity

HSV keratitis is the most frequent cause of corneal blindness in the United States, with reports of any visual disability as high as 40%.

Sex

Herpes simplex has a slightly higher male predominance.

Age

The mean age of presentation is in the late fifth to early sixth decade of life.

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Contributor Information and Disclosures
Author

Robert H Graham, MD  Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society

Disclosure: WebMD/eMedicine Salary Employment

Coauthor(s)

Kerry Assil, MD  Medical Director and CEO, The Sinskey Eye Institute

Kerry Assil, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Association for Research in Vision and Ophthalmology, and Contact Lens Association of Ophthalmologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Kilbourn Gordon III, MD, FACEP  Urgent Care Physician

Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Carr DJ, Tomanek L. Herpes simplex virus and the chemokines that mediate the inflammation. Curr Top Microbiol Immunol. 2006;303:47-65. [Medline].

  2. Liesegang TJ, Melton LJ 3rd, Daly PJ, Ilstrup DM. Epidemiology of ocular herpes simplex. Incidence in Rochester, Minn, 1950 through 1982. Arch Ophthalmol. Aug 1989;107(8):1155-9. [Medline].

  3. Saini JS, Agarwala R. Clinical pattern of recurrent herpes simplex keratitis. Indian J Ophthalmol. Mar 1999;47(1):11-4. [Medline].

  4. Holland EJ, Schwartz GS. Classification of herpes simplex virus keratitis. Cornea. Mar 1999;18(2):144-54. [Medline].

  5. Levy J, Lapid-Gortzak R, Klemperer I, Lifshitz T. Herpes simplex virus keratitis after laser in situ keratomileusis. J Refract Surg. Jul-Aug 2005;21(4):400-2. [Medline].

  6. Lu CK, Chen KH, Lee SM, Hsu WM, Lai JY, Li YS. Herpes simplex keratitis following excimer laser application. J Refract Surg. May 2006;22(5):509-11. [Medline].

  7. Kothari MT, Mehta BK, Asher NS, Kothari KJ. Recurrence of bilateral herpes simplex virus keratitis following bimatoprost use. Indian J Ophthalmol. Mar 2006;54(1):47-8. [Medline].

  8. Wilhelmus KR. Diagnosis and management of herpes simplex stromal keratitis. Cornea. 1987;6(4):286-91. [Medline].

  9. Zaher SS, Sandinha T, Roberts F, Ramaesh K. Herpes simplex keratitis misdiagnosed as rheumatoid arthritis-related peripheral ulcerative keratitis. Cornea. Nov 2005;24(8):1015-7. [Medline].

  10. Seitzman GD, Cevallos V, Margolis TP. Rose bengal and lissamine green inhibit detection of herpes simplex virus by PCR. Am J Ophthalmol. Apr 2006;141(4):756-8. [Medline].

  11. Tabbara KF. Treatment of herpetic keratitis. Ophthalmology. Sep 2005;112(9):1640. [Medline].

  12. Miserocchi E, Modorati G, Galli L, Rama P. Efficacy of valacyclovir vs acyclovir for the prevention of recurrent herpes simplex virus eye disease: a pilot study. Am J Ophthalmol. Oct 2007;144(4):547-51. [Medline].

  13. Koelle DM, Ghiasi H. Prospects for developing an effective vaccine against ocular herpes simplex virus infection. Curr Eye Res. Nov 2005;30(11):929-42. [Medline].

  14. Pepose JS, Keadle TL, Morrison LA. Ocular herpes simplex: changing epidemiology, emerging disease patterns, and the potential of vaccine prevention and therapy. Am J Ophthalmol. Mar 2006;141(3):547-557. [Medline].

  15. Wilhelmus KR, Gee L, Hauck WW, et al. Herpetic Eye Disease Study. A controlled trial of topical corticosteroids for herpes simplex stromal keratitis. Ophthalmology. Dec 1994;101(12):1883-95; discussion 1895-6. [Medline].

  16. Kaufman HE, Martola EL, Dohlman CH. Herpes simplex treatment with IDU and corticosteroids. Arch Ophthalmol. 1963;69:468-72.

  17. Rao SN. Treatment of herpes simplex virus stromal keratitis unresponsive to topical prednisolone 1% with topical cyclosporine 0.05%. Am J Ophthalmol. Apr 2006;141(4):771-2. [Medline].

  18. Cobo LM, Coster DJ, Rice NS, Jones BR. Prognosis and management of corneal transplantation for herpetic keratitis. Arch Ophthalmol. Oct 1980;98(10):1755-9. [Medline].

  19. Sozen E, Avunduk AM, Akyol N. Comparison of efficacy of oral valacyclovir and topical acyclovir in the treatment of herpes simplex keratitis: a randomized clinical trial. Chemotherapy. 2006;52(1):29-31. [Medline].

  20. de Rojas Silva MV, Diez-Feijoo E, Javaloy J, Sanchez-Salorio M. Prophylactic perioperative antiviral therapy for LASIK in patients with inactive herpetic keratitis. J Refract Surg. Apr 2006;22(4):404-6. [Medline].

  21. Herpetic Eye Disease Study Group. A controlled trial of oral acyclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis. The Epithelial Keratitis Trial. Arch Ophthalmol. Jun 1997;115(6):703-12. [Medline].

  22. Herpetic Eye Disease Study Group. A controlled trial of oral acyclovir for iridocyclitis caused by herpes simplex virus. Arch Ophthalmol. Sep 1996;114(9):1065-72. [Medline].

  23. Herpetic Eye Disease Study Group. Acyclovir for the prevention of recurrent herpes simplex virus eye disease. Herpetic Eye Disease Study Group. N Engl J Med. Jul 30 1998;339(5):300-6. [Medline].

  24. Kaiserman I, Kaiserman N, Nakar S, Vinker S. Herpetic eye disease in diabetic patients. Ophthalmology. Dec 2005;112(12):2184-8. [Medline].

  25. Kabra A, Lalitha P, Mahadevan K, Prajna NV, Srinivasan M. Herpes simplex keratitis and visual impairment: a case series. Indian J Ophthalmol. Mar 2006;54(1):23-7. [Medline].

  26. Li H, Zhang J, Kumar A, Zheng M, Atherton SS, Yu FS. Herpes simplex virus 1 infection induces the expression of proinflammatory cytokines, interferons and TLR7 in human corneal epithelial cells. Immunology. Feb 2006;117(2):167-76. [Medline].

  27. Prabriputaloong T, Margolis TP, Lietman TM, Wong IG, Mather R, Gritz DC. Atopic disease and herpes simplex eye disease: a population-based case-control study. Am J Ophthalmol. Nov 2006;142(5):745-9. [Medline].

 
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