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Bilateral herpetic keratoconjunctivitis.

Paula Márcia F Souza1, Edward J Holland, Andrew J W Huang

  • 1Department of Ophthalmology, University of Minnesota, 516 Delaware Street SE, Minneapolis, MN 55455, USA.

Ophthalmology
|March 8, 2003
PubMed
Summary

Bilateral herpetic keratitis, unlike unilateral cases, often presents with underlying atopy or immune issues, leading to prolonged courses. Long-term antiviral prophylaxis significantly reduces recurrence in these patients.

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Immunology

Background:

  • Herpes simplex virus (HSV) keratitis is a common cause of corneal blindness.
  • Bilateral involvement is less common than unilateral HSV keratitis.
  • Understanding the characteristics of bilateral herpetic keratitis is crucial for effective management.

Purpose of the Study:

  • To review the clinical characteristics of patients with bilateral herpetic keratitis.
  • To evaluate the visual outcomes in patients with bilateral herpetic keratitis.
  • To assess the impact of prophylactic antiviral treatment on recurrence rates.

Main Methods:

  • Retrospective, noncomparative, observational case series.
  • Reviewed medical records of 544 patients with HSV eye disease.

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  • Identified seven patients (1.3%) with bilateral herpetic keratoconjunctivitis.

    • Main Results:

    • Patients presented with a range of corneal complications including epithelial keratitis, stromal keratitis, and necrotizing stromal keratitis.
    • Common comorbidities included systemic atopy and ocular rosacea.
    • Four patients on long-term oral antiviral prophylaxis (acyclovir) showed significant decreases in recurrence, with an average remission of 1.7 years.
    • Visual acuity was 20/40 or worse in 42.8% of affected eyes.

    Conclusions:

    • Bilateral herpetic keratitis is associated with underlying atopy or immune deviations, leading to more protracted clinical courses compared to unilateral cases.
    • Long-term prophylactic antiviral treatment is effective in reducing recurrence rates in patients with bilateral herpetic keratitis.
    • These findings highlight the importance of considering immune status and long-term management strategies for bilateral HSV keratitis.