Herpes eye disease is a group of eye disorders caused by infection with the herpes simplex virus hsv. Erpes simplex virus hsv is a leading cause of corneal opacification and infectionrelated visual loss. Herpetic eye disease what it is, what causes it, and how to. One unresolved issue involves the use of corticosteroids in the treatment of hsv stromal keratitis. The involvement of both eyes occurs more often in young patients. It has been described in patients with atopy 1 and in patients with an altered immune system 2. Herpetic eye disease what it is, what causes it, and how. Most people are exposed to these viruses during their childhood and carry the dormant. Herpetic eye disease study heds ii purpose to determine whether early treatment with oral acyclovir of herpes simplex virus hsv ulcerations of the corneal epithelium prevents progression to the blinding complications of stromal keratitis and iridocyclitis. Herpes simplex virus hsv keratitis clinical presentation. Acyclovir for the prevention of recurrent herpes simplex virus eye disease. Based on nearly four decades of practical and scientific work and experience with followups in thousands of herpes patients.
To learn the appropriate topical or oral treatment and dosing for various forms of herpetic eye disease. Herpes simplex keratitis is a leading cause of corneal opacification in the united states, other industrialized countries, and developing nations throughout the world. To evaluate the efficacy of oral acyclovir in treating stromal keratitis caused by herpes simplex virus hsv in patients receiving concomitant topical. The herpetic eye disease study group also conducted a wellcontrolled, randomized clinical trial of oral aciclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis. Four of ten patients treated with idoxuridine worsened but subsequently responded to topical prednisolone 0. The treatment of herpes simplex virus hsv infections of the eye has been controversial for many years. Anna bedwell started with the iu school of optometry as a visiting clinical faculty member in 2011. Between 1993 and 1997, the herpetic eye disease study heds randomized 703 participants with ocular hsv to receipt of acyclovir or placebo for prevention of ocular hsv recurrence. Herpetic keratitis definition of herpetic keratitis by. Herpetic eye disease is caused by the herpes simplex and herpes zoster viruses. Herpes simplex eye infection, usually herpes simplex epithelial keratitis, may be triggered by excessive sun exposure, stress or illness eg fever. Herpetic eye disease an overview sciencedirect topics. Acyclovir for the prevention of recurrent herpes simplex. Herpetic eye disease study heds i ich gcp clinical trials.
Herpes simplex the cause of cold sores or fever blisters on the lips and face and herpes zoster the cause of chickenpox or. Both viruses lie dormant in the body until triggered to reactivate. Hedsrfs is evaluating the effect of psychological, environmental, and biological factors on recurrences of herpetic eye disease. In general, herpetic eye disease is characteristically unilateral.
An antiviral medicine given through an iv intravenous line may be needed. Color atlas of herpetic eye disease a practical guide to. There is still considerable controversy, even among knowledgeable ophthalmologists, on the optimal management of herpetic eye disease. Here is a breakdown of key findings that can be directly applied to clinical practice.
The herpetic eye disease study focused in part on the use of oral acyclovir to prevent hsv epithelial and stromal keratitis and provides valuable epidemiologic data, particularly with regard to recurrence rates. Herpes simplex virus hsv is the most common infective cause of blindness in developed countries, with a reported incidence of 5. Bilateral herpetic keratitis presenting with unilateral. In rare cases, it can also cause infection of your brain and tissues around your brain.
Recent findings there are a number of surgical therapies available for herpes keratitis. The herpetic eye disease study heds, performed in the usa, was a multiarmed set of five randomized, placebocontrolled trials designed to determine best treatments and prophylaxis for hsv keratitis and one epidemiologic study that investigated risk factors. The herpetic eye disease study heds concluded that there was no clinically significant effect of oral acyclovir in patients with hsv stromal keratitis who received concomitant topical corticosteroids and trifluridine. Herpes simplex keratitis is, in general, a unilateral disease, but bilateral occurrence has been reported in 1. Herpes simplex virus hsv causes a variety of diseases including the recurrent ulceration, inflammation, and scarring of the cornea known as herpes simplex keratitis, which is a major cause of blindness worldwide. Association between unprotected ultraviolet radiation. A controlled trial of oral acyclovir for iridocyclitis caused by herpes simplex virus. Herpetic eye disease is caused by a virus, either herpes simplex or herpes zoster. The primary outcome was the time to the first recurrence of any type of hsv eye disease in either eye. The herpetic eye disease study was a series of randomized, doublemasked placebocontrolled clinical trials that looked at various approaches to treating ocular herpes simplex virus keratitis. Most herpesvirus infections are mild or asymptomatic. Whenever we diagnose herpes virus in the eye, i like to stress to my patients that this is not a sexually transmitted disease that theyve caught. Members of the herpetic eye disease study group are listed in the appendix.
The recent heds trial on the efficacy of oral acyclovir as prophylaxis against recurrent stromal keratitis represents the first report of a treatment likely to reduce longterm scarring from herpetic disease. Introduction herpetic eye disease is the most common infectious cause of corneal blindness in developed countries 60% of co. Herpesviruses are a prominent cause of human viral disease, second only to the cold and influenza viruses. Herpetic eye disease or ocular herpes refers to any eye problem due to infection by the herpes simplex virus. Infection of the eye by herpes simplex virus hsv is a leading cause of corneal blindness in the united states and other countries. When this happens, the condition is known as herpetic eye disease. Risk factors for herpes simplex virus epithelial keratitis. Nov 15, 2003 the herpetic eye disease study was a series of randomized, doublemasked placebocontrolled clinical trials that looked at various approaches to treating ocular herpes simplex virus keratitis. However, when the virus invades the eye, a number of pathologies can develop and its associated sequelae have become a considerable source of ocular morbidity. But most people infected with hsv dont get herpes eye disease. This study showed that both the affected and fellow eyes of the patients with unilateral herpetic epithelial keratitis are affected in terms of. Clinical examinations were performed after treatment trial months 1.
The homogenous, wellstructured content and index make it easy for the reader to find the necessary information rapidly. Initial episodes cause eye irritation and a foreign body sensation, though repeat bouts are less. A controlled trial of topical corticosteroids for herpes simplex stromal keratitis. Pdf file of the complete article 738k, or click on a page image below to browse page by page.
Herpetic eye disease is the most common infectious cause of corneal blindness in this country. The treatment for herpetic eye disease is usually a combination of topical antiviral drops such as viroptic or zirgan and an oral antiviral like acyclovir or valtrex. You will need to know what this disease is as well as. There are several viable options for treating a patient with herpetic eye disease. Despite the availability of antiviral agents that are effective in treating herpes simplex epithelial keratitis, inflammation in the corneal connective tissue and iris that can lead to corneal scarring and visual impairment develops in many patients. Acyclovirresistant corneal hsv1 isolates from patients with herpetic keratitis.
For active treatment 400 mg five times daily in nonimmunocompromised patients. Simultaneous bilateral development of herpetic keratitis is very rare. Vaughan asburys general ophthalmology 16th edition, 67. Herpes simplex the cause of cold sores or fever blisters on the lips and face and herpes zoster the cause of chickenpox or shingles are two viruses that can occasionally affect the eyes. Bilateral herpetic keratitis is known to develop in patients with a compromised immune system, such as those with congenital immune deficiencies, atopy, longterm immunosuppression, or recipients of organ transplants. Prior to the hedsi trials, the role of topical corticosteroids in the management of hsv stromal keratitis was uncertain. Hsv keratitis is an infection of the eye that can have severe negative effects. According to a 2006 study, one in four people over age 30 is infected with hsv2.
Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of the. The viruses are not the same that result in genital herpes, but cause a painful condition with redness and rashes around the eye. When the eye is involved we typically see a dendritic corneal ulcer on the surface of the eye. K r wilhelmus, c r dawson, b a barron, p bacchetti, l gee, d b jones, h e kaufman, j sugar, r a hyndiuk, p r laibson, r d stulting, and p a asbell. The impact of the herpetic eye disease studies on the.
Herpes simplex keratitis treatment herpetic eye disease study heds epithelial disease debridement also use for pcr or culture monotherapy with topical antiviral aciclovir, ganciclovir,trifluridine no added benefit of oral antiviral but may be useful in kids or allergic patients normal dendrites heal in weeks if not think toxicity. We call it dendritic because the infection forms a classic fernleaf pattern on the cornea. Psychological stress and other potential triggers for. Dec 15, 2014 herpesviruses are a prominent cause of human viral disease, second only to the cold and influenza viruses. This study showed that both the affected and fellow eyes of the patients with unilateral herpetic epithelial keratitis are affected in terms of dry eye without any significant loss in. Introduction herpetic eye disease is the most common infectious cause of corneal blindness in developed countries 60% of corneal ulcers in developing countries 10 million people worldwide may have herpetic eye disease herpes simplex virus hsv. Herpes eye disease can also raise the pressure in your eye. A controlled trial of oral acyclovir for herpes simplex stromal keratitis author links open overlay panel bruce a. Twenty patients with presumptive herpetic iridocyclitis without active corneal inflammation received either topical idoxuridine 0. Pdf the epidemiology of herpes simplex virus eye disease in. To study the incidence of herpetic eye disease hed of the ocular surface in diabetics.
Recurrent herpetic eye disease case studies publisher april 14, 2020 by associate professor colin chan mbbshons franzcob this cpd course is now available on specsavers mycpd portal. The herpetic eye disease study jama ophthalmology jama. Ppt viral keratitis powerpoint presentation free to. The herpetic eye disease study heds has guided the management of herpetic eye disease for almost twenty years, but newer medications such as valacyclovir are now available and are considered to. Herpetic eye disease study heds i full text view clinicaltrials. An estimated 450,000 people in the united states can develop recurrent episodes of the disease and about 46,000 episodes of hsv eye infection every year. There are an estimated 500 000 episodes of eye disease with herpes simplex virus in the united states each year, and herpetic infections of the eye are a major cause of corneal opacity and visual loss. The uveitis of all ten patients treated with acyclovir resolved within one to eight weeks.
Herpetic eye disease disclosure statement no financial disclosures brad sutton, od, faao iu school of optometry. Herpes simplex virus can cause cold sores around the mouth and can sometimes affect the eye. Wilhelmus kr, dawson cr, barron ba, bacchetti p, gee l, jones db, kaufman he, sugar j, hyndiuk ra, laibson pr, stulting rd, asbell pa. A controlled trial of oral acyclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis. The study outcome was defined as the first recurrence of active hsv eye disease in any form blepharitis, conjunctivitis, epithelial keratitis, stromal keratitis, andor iridocyclitis confirmed on examination by a certified study ophthalmologist using slitlamp biomicroscopy. A second issue relates to the use of the potent antiviral, acyclovir, which has been demonstrated to be effective in preventing recurrences of hsv genital infections.
Get a printable copy pdf file of the complete article 738k, or click on a page image below to browse page by page. Pdf the epidemiology of herpes simplex virus eye disease. Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of. Studies have suggested that exposure to ultraviolet uv light may increase risk of herpes simplex virus hsv recurrence. The infection can lead to corneal scarring and neovascularization, permanent endothelial dysfunction and corneal edema, secondary glaucoma, and cataract. Providing the virus is susceptible, treatment with topical antiviral agents such as acyclovir acv hastens resolution and improves outcome. Scribd is the worlds largest social reading and publishing site. Mar 19, 2014 herpes simplex keratitis treatment herpetic eye disease study heds epithelial disease debridement also use for pcr or culture monotherapy with topical antiviral aciclovir, ganciclovir,trifluridine no added benefit of oral antiviral but may be useful in kids or allergic patients normal dendrites heal in weeks if not think toxicity. Ophthalmic herpes simplex virus hsv of the anterior. In vivo confocal microscopy in bilateral herpetic keratitis.