Diagnosis and management of herpes simplex ocular infection

The multifaceted nature of ocular herpes simplex has become more clearly defined in recent years, as it has become apparent that it is a disease characterized by both infectious and immune components. Therapy Therapy of infectious epithelial dendritic-geographic disease is generally gentle debridement of the ulcer followed by antimetabolite chemotherapy with IDU or Ara A. Tropic (metaherpetic) ulceration may occur postinfection and is caused by sterile basement membrane damage, which makes it difficult for the epithelium to heal across the damaged ulcer base. Therapy is generally that of recurrent erosion and involves patching, soft contact lenses, and lubricating drops and ointments. Stromal disease may be (1) viral interstitial keratitis, which is slowly responsive to antiviral therapy, or (2) immune disciform reaction, which may or (hopefully) may not necessitate steroid therapy with prophylactic antiviral and antibiotic cover. Herpetic iritis may occur alone or with any form of corneal disease. While it is generally felt to be caused by intact intraocular virus, therapy is still steroid-oriented for lack of more effective and penetrating antiviral drugs. Antimetabolite-induced medicamentosa may mimic almost any form of herpetic disease and should be ruled out in any differential diagnosis of a patient deteriorating under therapy.