Management of herpes simplex keratitis: problems associated with epithelial disease

Area of Science:

• Ophthalmology
• Microbiology
• Infectious Diseases

Background:

• Effective topical antiviral agents exist for corneal epithelial infections.
• Diagnosing and managing active viral replication in the corneal epithelium presents challenges.
• Lesions mimicking herpes simplex virus epithelial infection are numerous, with Acanthamoeba infection now recognized.

Purpose of the Study:

• To highlight the diagnostic and management complexities of active viral replication in the corneal epithelium.
• To discuss differential diagnoses, including Acanthamoeba infection, that can mimic herpetic epithelial keratitis.
• To address complications arising from antiviral agent toxicity and corticosteroid use.

Main Methods:

• Literature review of corneal infections and their mimics.
• Analysis of clinical case presentations involving difficult-to-diagnose epithelial lesions.
• Discussion of treatment strategies and potential complications.

Main Results:

• Herpes simplex virus (HSV) epithelial keratitis management is complicated by differential diagnoses.
• Acanthamoeba keratitis can present with signs similar to HSV epithelial infections.
• Antiviral toxicity and corticosteroid administration can obscure diagnoses and impede effective management.

Conclusions:

• Accurate diagnosis of corneal epithelial infections requires careful consideration of mimics.
• Management strategies must account for potential drug toxicities and inflammatory responses.
• A high index of suspicion for non-viral etiologies is crucial in challenging cases of epithelial keratitis.