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Late ophthalmologic manifestations of neonatal herpes simplex virus infection
M el Azazi1, G Malm, M Forsgren
1Department of Ophthalmology, Huddinge University Hospital, Sweden.
Insights
Neonatal herpes simplex virus infection can cause significant ocular abnormalities in children, even years later. Long-term monitoring is crucial for detecting these vision-impairing complications.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Neonatal herpes simplex virus (HSV) infection is a serious condition with potential long-term sequelae.
- Ocular manifestations of neonatal HSV are not well-characterized in long-term follow-up studies.
Purpose of the Study:
- To investigate the prevalence and types of ocular abnormalities in children with a history of virologically confirmed neonatal HSV infection.
- To assess the relationship between neurological impairment and ocular findings in this cohort.
Main Methods:
- A retrospective study examining 32 children 1-15 years post-neonatal HSV infection.
- Ophthalmological examinations were performed to identify ocular abnormalities.
- Neurological status was assessed to correlate with visual outcomes.
Main Results:
- 94% of neurologically impaired children had ocular abnormalities versus 20% of neurologically healthy children.
- Ocular morbidity (cataracts, corneal scars, optic atrophy, chorioretinal scars) was present in 40% of all children.
- Severe handicap was associated with impaired vision, primarily cortical blindness, in 93% of affected children.
Conclusions:
- Ocular complications are common sequelae of neonatal HSV infection, affecting both neurologically impaired and healthy children.
- Long-term ophthalmological surveillance is essential for early detection and management of vision-threatening conditions.
- Recurrences of ocular manifestations may occur, necessitating ongoing monitoring.
Abstract:
We examined 32 children one to 15 years after virologically verified neonatal herpes simplex virus infection. Sixteen of 17 (94%) neurologically impaired children had ocular abnormalities compared to three of 15 (20%) neurologically healthy children. Disturbed oculomotor control occurred in 14 children (44%), most of whom were among those with severe handicap. Ocular morbidity was present in 13 (40%) of 32 children: one had cataracts, two had corneal scars, seven had optic atrophy, and nine had chorioretinal scars. The clinically silent chorioretinal lesions were manifest as coarse hyperpigmented areas between the equator and ora serrata. One child had suffered from acute fulminant retinitis. Twelve of 13 (93%) severely handicapped children had impaired vision, mainly because of cortical blindness. Less affected children had normal vision unless corneal scars were present. Long-term observation of patients with neonatal herpes infections is essential because ocular manifestations are not rare, and recurrences may be more common than previously reported.