How is recurrent herpes simplex virus (HSV) keratitis prevented?

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

The major difficulties in treating herpetic keratitis relate to the tendency for recurrences and to the management of stromal disease. In its latent form, HSV can be present in the cells of the cornea and in the central connections of the trigeminal nerve, particularly in the trigeminal ganglion. Disturbance of host defense results in reactivation of the virus, its subsequent passage centrifugally along the nerve, and resultant shedding from the nerve endings. Corneal lesions occur when the balance between latency and reactivation is disturbed, such as during febrile illnesses, during menses, or on exposure to sunlight. Once trigger factors are identified, they need to be avoided.

Using 400 mg of acyclovir once or twice daily as prophylaxis can reduce the incidence of recurrence. [32, 33] This is recommended for patients with recurrent stromal disease or more than 2 episodes of epithelial disease per year. [34, 35]

Active HSV keratitis is an absolute contraindication to laser corneal refractive surgery (ie, LASIK, PRK) or other corneal procedures (collagen cross-linking). Inactive keratitis or a history of previous HSV disease is also considered a relative contraindication. Recurrence of HSV keratitis after refractive surgery is a well-known complication. However, case reports have documented good refractive surgery outcomes in selected patients whose keratitis has been inactive for at least 1 year and in whom perioperative systemic antiviral prophylaxis is used. [36, 37, 38]


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