Herpes simplex and recurrent corneal disease

The management of a patient with ocular HSV is a challenge for the ophthalmologist. Attacks may vary in clinical presentation with each episode. Patients should be instructed to contact their ophthalmologist at the first sign of a problem. Because a recurrent attack may be painless, patients may be reluctant to seek medical attention. Therefore, I give patients three easy warning signs to remember. They are instructed to contact me if the eye becomes red or painful or the vision decreases. Those patients with a history of ocular HSV who will undergo immuno-suppression (e.g., renal transplant) must be watched closely (Fig. 5). I often recommend several drops per day of prophylactic trifluridine for these patients while they are on steroid therapy and immunosuppressives. Because of the dangers of corticosteroids without antiviral cover, I instruct patients to emphasize their history of herpetic ocular disease to any physician who may want to treat the patient with corticosteroids. In those patients in whom a trigger mechanism can be identified, I may also recommend prophylactic antiviral agents to be taken at the time that such mechanisms are likely to be activated. Because minor trauma can precipitate a recurrent attack in some patients, I discourage cosmetic contact lens wear in these patients. There has been no form of therapy to date that has decreased the recurrence rate for HSV infections. Research to develop a vaccine that would prevent herpetic latency is ongoing. Such a vaccine theoretically would make herpetic ocular disease nonrecurrent . In our own laboratories at the University of Cincinnati College of Medicine, we have been working with a promising vaccine prepared against the early viral-induced proteins. Thus far, this vaccine has prevented latency in experimental animals. Perhaps it will prevent latency in the human. Further work with newer antiviral agents such as acyclovir may aid in our fight against this disease. Interferon may also find a place in the possible prevention and treatment of recurrent herpetic ocular disease. In the meantime, different forms of recurrence with almost every conceivable complication can occur. The ophthalmologist must, therefore, be diligent in the management of his or her patients with ocular herpetic disease.