Herpes Stromal Keratitis: Erosion of Ocular Immune Privilege by Herpes Simplex Virus

Jared E Knickelbein; Kristine-Ann Buela; Robert L Hendricks


Future Virology. 2010;5(6):699-708. 

In This Article


Herpes stromal keratitis is a potentially blinding complication of ocular HSV infection. Corneal infection with HSV leads to the infiltration of immune cells and in-growth of both blood and lymph vessels into the normally immune-privileged and avascular cornea. If not treated properly, and in a timely fashion, chronic inflammatory changes within the stromal architecture can ensue, often resulting in irreparable scarring and visual loss. Current treatment options include topical antivirals to inhibit viral replication, and corticosteroids to combat the destructive effects of the immune system within the cornea. Other potentially effective treatments include cyclosporin A to inhibit CD4 T-cell-mediated immunopathology and/or antiangiogenic agents, such as bevacizumab, to inhibit angiogenesis.

Most cases of HSK result from reactivation of latent virus within a previously infected host. Thus, strategies aimed at preventing recurrent bouts of viral reactivation and corneal scarring appear to be the best approach to treating this visually debilitating disease. A therapeutic vaccine designed to boost the protective CD8 T-cell population within HSV latently infected ganglia may offer a safe and effective method of blocking HSV reactivation from latency and recurrent ocular disease.


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