What are the treatment options for dendritic, geographic, and marginal corneal ulcers in herpes simplex virus (HSV) keratitis?

Updated: Jan 18, 2019
  • Author: Jim C Wang (王崇安), MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Dendritic, geographic, and marginal corneal ulcers can be treated as follows:

  • Débridement of the infected epithelium - Performed after instillation of topical anesthetic (4% cocaine or 0.5% proparacaine) into the conjunctival sac; the loose epithelium at the edge of the dendritic figure is wiped away with a sterile, cotton-tipped applicator or with the edge of a knife blade or a platinum spatula

  • Ganciclovir 0.15% gel, 5 times daily; trifluridine 1% drops, 9 times daily; vidarabine 3% ointment, 5 times daily; or 2 g of oral acyclovir, once daily

  • Cycloplegic agent

  • Topical steroids - May be used after several days of antiviral treatment in patients with marginal ulcers or associated stromal disease to quell the immune response and reduce long-term scarring

The attempt to augment or modify the host's immunologic milieu has led some investigators to study the role of cimetidine as an adjunct to standard antiviral therapy. The efficacy of this modality has not been fully established. [21, 22] In vitro studies using fusion proteins (which block the interaction of T cells with antigen-presenting cells) and basic fibroblastic growth factors have shown a beneficial effect of these as adjunctive treatments in decreasing the incidence of stromal keratitis and iridocyclitis.


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