Herpes simplex virus

• Published in: Acta ophthalmologica (Oxford, England) Vol. 89; no. s248
• Main Authors: KHAIRALLAH, M, ATTIA, S, NAHDI, I
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-09-2011; Wiley Subscription Services, Inc
• Subjects: Anterior chamber; Antiviral agents; Atrophy; Cornea; Corticoids; Corticosteroids; Diagnosis; Endothelium; Herpes simplex; Herpes simplex virus; Iris; Laboratories; Pain; Patients; Polymerase chain reaction; Pressure; Prognosis; Uveitis; Vision
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2011.4441.x

Purpose Herpetic simplex anterior uveitis (HSAU) is a major infectious entity. Prompt diagnosis of HSAU is essential, usually based on typical clinical features. Treatment is based on antivirals and corticosteroids.
Methods Review of clinical features, outcomes, and management of HSAU.
Results HSAU is typically acute and unilateral disease, with patients suffering from blurred vision, photophobia, pain, and redness. Inactive or active corneal involvement is often associated. The corneal sensation can be decreased relative to the controlateral cornea. However corneal involvement can be absent.Inflammation is more often granulomatous, and the typical herpetic keratic precipitates (KPs) are large, flat and usually do not respect the Arlt’s triangle, but tend to accumulate on the central corneal endothelium. Anterior chamber cells and flare of varying degrees of severity, with or without posterior synechiae, are noted. Iris atrophy and pupillary distortion are common. Increased intraocular pressure (IOP) is also frequently observed and is very suggestive. The IOP rise is related to acute trabeculitis. The course tends to be recurrent. Laboratory tests are necessary especially in patients with atypical clinical presentation. Detection of viral DNA in ocular fluids by PCR is the gold standard for the laboratory diagnosis of HSAU. The key to successful treatment of HSAU is the use of topical corticosteroids combined with systemic antivirals for the treatment of recurrences followed by prophylactic antiviral therapy combined with low‐dose corticosteroid drops. Visual prognosis might be good, especially in patients who have only anterior uveitis without corneal desease
Conclusion An increased awareness of the characteristic clinical features and the role of PCR for early diagnosis and appropriate treatment are important.