Association between unilateral quiescent stromal herpetic keratitis and bilateral dry eyes

According to our clinical observation, patients with quiescent herpes simplex virus (HSV) stromal keratitis often seem to present with signs of dry eye in the contralateral eye. Our goal was to compare dry eye signs and symptoms in both eyes of patients with quiescent HSV stromal keratitis with those of age- and sex-matched control subjects with healthy corneas.

A case-control study with 24 subjects per group.

The average age of 10 men and 14 women in each group was 58 years. The HSV eye of cases was first compared with the contralateral eye with a healthy cornea. As expected, the HSV eye had a significantly lower corneal sensation threshold (P = 0.001); no significant difference was however found for Schirmer tests done with anesthesia (basal tear secretion) and without anesthesia, tear breakup time, mucus and debris in the tear film, and eyelid margin redness or swelling. Then, the HSV eye of cases was compared with the right eye of controls, whereas the healthy eye of cases was compared with the left eye of controls. Patients with unilateral quiescent HSV stromal keratitis had significantly lower bilateral Schirmer tests both with anesthesia (P = 0.001) and without anesthesia (P = 0.02). Dry eye symptoms of the healthy cornea of cases and those of controls did not differ significantly.

Both eyes of patients with quiescent HSV stromal keratitis in our population were dry even if many patients with HSV stromal keratitis did not have symptoms in their fellow eye.