Overview
Herpes simplex keratitis (HSK) is an ocular infection caused by herpes simplex virus (HSV), leading to inflammation of the cornea and potentially vision-threatening complications including ulceration and scarring 14.Diagnosis
Clinical presentation includes dendritic ulcers (superficial keratitis) and geographic ulcers (stromal keratitis) 4.
Corneal scraping smears analyzed via immunoperoxidase staining (PAP technique) with HSV antisera can confirm HSV presence, particularly useful in superficial keratitis 4.
Corneal sensation testing using aesthesiometers can aid in assessing nerve damage, though no specific thresholds are defined for HSK diagnosis 5.Management
First-line treatment: Antiviral therapy, typically acyclovir, valacyclovir, or famciclovir, based on clinical guidelines though specific doses are not detailed in abstracts 1.
Adjunctive treatments: Topical antivirals such as trifluridine or ganciclovir for severe or stromal keratitis 1.
Prophylaxis: Oral antiviral prophylaxis recommended post-penetrating keratoplasty in patients with prior HSK/HZO to prevent recurrence (consider latent period between disease and prophylaxis initiation) 1.Special Populations
Postoperative patients: Oral prophylaxis advised after penetrating keratoplasty in those with a history of HSK/HZO to prevent recurrence 1.
Comorbidities: No specific guidance provided for pregnancy, pediatrics, or elderly populations in the abstracts 12345.Key Recommendations
Recommend oral antiviral prophylaxis post-penetrating keratoplasty for patients with a history of HSK/HZO to prevent recurrence (Evidence: Strong) 1.
Consider a latent period between the last episode of HSK/HZO and initiation of prophylactic antiviral therapy post-surgery (Evidence: Moderate) 1.
Use immunoperoxidase staining (PAP technique) for corneal scrapings to diagnose HSK, especially in cases of superficial keratitis (Evidence: Moderate) 4.References
1 Gessa-Sorroche M, Kanclerz P, Alio J. Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery. Archivos de la Sociedad Espanola de Oftalmologia 2022. link
2 Reed SY, Shin DH, Birt CM, Rhee RK. Herpes simplex keratitis following argon laser trabeculoplasty. Ophthalmic surgery 1994. link
3 Burton J, Hood C. Herpes ophthalmicus. The Practitioner 1989. link
4 Kobayashi TK, Mizuhara S, Arai M, Sawaragi I. Application of immunoperoxidase staining in the cytodiagnosis of herpes simplex keratitis. Diagnostic cytopathology 1985. link
5 Beuerman RW, McCulley JP. Comparative clinical assessment of corneal sensation with a new aesthesiometer. American journal of ophthalmology 1978. link90127-7)