Modalities to decrease stromal herpes simplex keratitis reactivation rates.

Area of Science:

• Ophthalmology
• Immunology

Background:

• Herpes simplex keratitis (HSK) is a recurrent viral infection of the cornea.
• Dry eye disease (DED) is a common comorbidity that can exacerbate HSK.
• Managing recurrent HSK in patients with DED requires effective adjunctive therapies.

Purpose of the Study:

• To assess the efficacy of punctal occlusion and topical cyclosporine as adjunctive treatments for reducing HSK recurrences.
• To compare the outcomes of these treatments in patients with coexisting stromal HSK and DED.

Main Methods:

• A retrospective analysis of 42 patients with unilateral HSK and DED.
• Patients received either thermal cautery punctal occlusion or topical cyclosporine (0.05%) twice daily.
• A subgroup received combined punctal occlusion and cyclosporine.
• All patients continued oral antivirals and topical steroids.

Main Results:

• Both thermal cautery punctal occlusion and topical cyclosporine significantly reduced the annual duration of HSK recurrences from over 7 months to approximately 1 month.
• Adding topical cyclosporine to prior punctal occlusion further decreased the recurrence duration from 1.3 to 0.8 months per year.

Conclusions:

• Permanent punctal occlusion via thermal cautery is effective in reducing stromal HSK recurrences.
• Topical cyclosporine is also effective as a standalone or adjunctive therapy for managing recurrent stromal HSK.
• These treatments offer a viable strategy for patients with HSK and DED.