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. Herpetic eye disease is the most common infectious cause of corneal blindness in this country. Joseph gallagher, od, faao dorothy hitchmoth, od, faao, diplom. The introduction of oral antiviral prophylaxis constituted a major advance in the management of chronic herpetic eye disease. Risk factors for herpes simplex virus epithelial keratitis. The problem may be caused by herpes zoster ophthalmicus if your doctor finds some or all of these symptoms. An estimated 400,000 americans have had ocular hsv disease, and there are nearly 50,000 new and recurrent cases each year in the united states.
Proctor foundation, university of california, san francisco 941430412. One unresolved issue involves the use of corticosteroids in the treatment of hsv stromal keratitis. A controlled trial of topical corticosteroids for herpes simplex stromal keratitis. Introduction herpetic eye disease is the most common infectious cause of corneal blindness in developed countries 60% of co. Viral infections such as herpetic keratitis caused by herpes simplex virus 1 hsv1 can cause serious complications that may lead to blindness. While episodes of herpes simplex virus hsv epithelial keratitis can be treated effectively, recurrences may lead to corneal stromal scarring and decreased visual acuity. Herpes simplex virus hsv is a very common infection that has been reported to be present in the trigeminal ganglion of nearly 100% of patients greater than age 60 at autopsy. It is based on nearly four decades of practical and scientific work and experience with followups in thousands of herpes patients. The study population included 260 patients who had active stromal keratitis andor iridocyclitis without epithelial disease and who were enrolled in one of three clinical trials of the herpetic. A multicenter randomized clinical trial rct to look at whether longterm treatment will be effective in decreasing eye disease andor chronic pain in patients with a form of shingles, called herpes zoster ophthalmicus, which affects the eye. Both viruses lie dormant in the body until triggered to reactivate. Listing a study does not mean it has been evaluated by the u. 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. Dec 15, 2014 herpesviruses are a prominent cause of human viral disease, second only to the cold and influenza viruses.
Barron ba, gee l, hauck ww, herpetic eye disease study. The treatment of herpes simplex virus hsv infections of the eye has been controversial for many years. Herpetic eye disease what it is, what causes it, and how. Herpesviruses are a prominent cause of human viral disease, second only to the cold and influenza viruses. Content for management of epithelial herpetic keratitis. The classification of hk was based on clinical criteria. 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. This was a retrospective, descriptive case study for five years of the eyes of patients with clinically diagnosed herpes simplex keratitis. Herpetic keratitis symptoms, diagnosis, treatments and. Recurrence of the disease is likely and cornea transplantation, therefore, might not be the ideal.
Current concepts in the management of herpes simplex anterior. One study compares a tapering dosage of topical prednisolone or placebo eye drops for hsv stromal keratitis hedsskn. The herpes family includes viruses that can affect the eye, just as they do the skin, mucous membranes and coverings of the brain. All subjects underwent a complete ophthalmological examination including in vivo laser. Topical ganciclovir in herpetic eye disease touchophthalmology. Herpetic eye disease or ocular herpes refers to any eye problem due to infection by the herpes simplex virus. The herpetic eye disease study jama ophthalmology jama. The most common culprits of herpetic eye disease are the herpes.
To study the incidence of herpetic eye disease hed of the ocular surface in diabetics. Data from the us national health and nutrition examination survey nhanes suggest an overall 58% seroprevalence rate for hsv1the predominant cause of herpes simplex keratitis 2 hskwith rates in individual. Patient priorities in herpes simplex keratitis bmj open. Developing a treatment algorithm 2 ocular infection with herpes simplex virus hsv affects approximately 400,000 individuals in the us and is a leading infectious cause of corneal blindness in the developed world.
Antiviral treatment following penetrating keratoplasty for. In regard to ocular disease, herpes simplex type 1 hsv i and hsv ii may cause blepharoconjunctivitis, epithelial keratitis, stromal keratitis necrotizing or nonnecrotizing, iridocyclitis, andor retinitis. Most of the treatment that we talk about when were talking about simplex keratitis was learned by the herpetic eye disease study. The herpetic eye disease study heds includes three doublemasked, placebocontrolled clinical trials for potentially blinding herpes simplex virus hsv eye infections. Hsv patients are usually referred to me because their diagnosis is unknown, said dr. Demystifying the ocular herpes simplex virus american. Herpetic eye disease an overview sciencedirect topics. Furthermore, previous bouts of hsk significantly increased the risk of future recurrences of stromal disease.
Herpes simplex keratitis is treated with topical antiviral therapy such as trifluridine solution viroptic every 2 hours or vidarabine ointment vira a every 3 hours. But, in fact most instances of herpes, at least those affecting the eye, are not sexually transmitted, and are not even the type of herpes that is usually associated with sexually transmitted disease. Volume 101, issue 12, december 1994, pages 18711882. 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. He or she will probably check the pressure inside the eye, for example. Most people are exposed to these viruses during their childhood and carry the dormant inactive viruses.
Recent findings there are a number of surgical therapies available for herpes keratitis. 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. This wellstructured atlas offers practical advice for the recognition and management of each herpetic eye problem. 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. The content was developed from material in the pubmed database.
Barron ba1, gee l, hauck ww, kurinij n, dawson cr, jones db, wilhelmus kr, kaufman he, sugar j, hyndiuk ra, et al. Tuli, associate professor of ophthalmology, director of the cornea and external diseases service, and residency program director at the university of florida. Wilhelmus kr, gee l, hauck ww, herpetic eye disease study. A practical guide to clinical management sundmacher, rainer on. Herpetic eye disease diagnosis and tests cleveland clinic. Herpes simplex virus epithelial keratitis accounted for 47% of ocular hsv cases in the heds trial, compared to 66. When this happens, the condition is known as herpetic eye disease. Oral agents that are available for the treatment of herpetic eye disease include acyclovir, ganciclovir, valaciclovir, valganciclovir, famciclovir, and foscarnet.
The impact of the herpetic eye disease studies on the. Studies of combined interferon and antiviral agents had inconsistent results. The objective of this study is to explore patients priorities for. 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. Ophthalmic herpes simplex virus hsv of the anterior. The impact of the herpetic eye disease studies on the management of herpes simplex virus ocular infections. Herpetic eye disease what it is, what causes it, and how to. Possible risk factors were evaluated for herpes simplex virus hsv epithelial keratitis in patients with stromal keratouveitis. Herpetic eye disease study heds i this study has been completed current. It is caused almost entirely by herpes simplex virus type 1 and varicellazoster. Color atlas of herpetic eye disease 2008 english pdf.
Clinical manifestations and treatment considerations of. Studies suggest that approximately 10 % of patients with epithelial keratitis will eventually experience stromal disease. Effective treatments for acute episodes of hsv have been verified by early herpetic eye disease study heds trials. Persistent dilemmas in zoster eye disease british journal. Acyclovir for the prevention of recurrent herpes simplex virus eye disease. After six months, all the patients with herpetic 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 the. All of them underwent a complete ophthalmological examination, cochetbonnet aesthesiometry and lscm within the central 5 mm of the cornea. Acyclovir for the prevention of recurrent herpes simplex. Tuli, md, when she thinks of herpes simplex virus hsv ocular disease. 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. Group thedsacyclovir for the prevention of recurrent herpes simplex virus eye disease. The applicant, a participant in the current herpetic eye disease study heds, proposes to be a regional coordinating center for phase ii of the herpetic eye disease study. Corneal subbasal nerve changes in patients with herpetic.
Acyclovirresistant corneal hsv1 isolates from patients with. Herpetic eye disease study phase ii heds ii robert hyndiuk. Sep 01, 2008 at the rotterdam eye hospital, between 1981 and 2005, corneal swabs from 173 patients who had suspected herpetic corneal lesions but who were otherwise healthy were obtained for diagnostic purposes. 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. Pdf group thedsacyclovir for the prevention of recurrent. 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. Oral antiviral agents may be used in patients who suffer from arthritis or hand tremors and are unable to use topical ointments, gels or eye drops. 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.
Phase ii will consist of two randomized, doublemasked clinical trials and a nonexperimental recurrence factors study of ocular herpetic disease. Acyclovir for the prevention of recurrent herpes simplex virus eye disease volume 339 number 5 301 of reproductive age agreed to use contraception during the oneyear treatment period and for three months thereafter. Virus was grown and typed for hsv1, as described elsewhere. The most common culprits of herpetic eye disease are the herpes simplex virus hsv. Design and organization of the herpetic eye disease study. With no published patient involvement exercises, patients priorities in hsk are unclear. Review of the patients after randomization revealed that 15 did not fulfill all the eligibility criteria. Involving patients in setting the research agenda maximises patient benefit and minimises research waste. Consequently, herpetic stromal keratitis is a common indication for corneal transplantation in many published reports. Some of the clinical trials listed on clinicaltrials. A prospective clinical study included 269 patients.
A controlled trial of oral acyclovir for herpes simplex stromal keratitis. Jul 02, 2009 the herpetic eye disease study heds includes three doublemasked, placebocontrolled clinical trials for potentially blinding herpes simplex virus hsv eye infections. In the herpetic eye disease study, 18% of patients diagnosed with hsv1 ocular disease experienced a recurrence involving the stroma, and stromal keratitis represented 44% of all recurrences. Scribd is the worlds largest social reading and publishing site.
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. A controlled trial of oral acyclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis. Many other conditions can display these symptoms, so it is necessary for a doctor to perform a full examination of the eye to learn the cause. On the basis of both animal and human studies, the antiviral agent acyclovir may both treat and prevent recurrence of hsv disease. The study population included 260 patients who had active stromal keratitis andor iridocyclitis without epithelial disease and who were enrolled in one of three clinical trials of the herpetic eye disease study. An evidencebased algorithm was developed in advance and finalized at a meeting on november 11, 2012 in chicago, il attended by expert eye physicians with specialization in corneal and infectious disease. 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 two subtypes are. The two different types of herpetic eye disease have different symptoms. By november 2012, approximately 28 clinical trials were approved to assess novel gene therapy agents. The primary outcome was the time to the first recurrence of any type of hsv eye disease in either eye. To record the natural history of herpes simplex keratitis and estimate visual impairment in eyes of patients diagnosed with herpes simplex keratitis materials. However, there is a relatively high risk of graft failure in this patient group.
Management of herpes simplex virus epithelial keratitis. Corneal transplantation for herpes simplex keratitis. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Herpes simplex eye infection, usually herpes simplex epithelial keratitis, may be triggered by excessive sun exposure, stress or illness eg fever. A controlled trial of oral acyclovir for herpes simplex stromal keratitis author links open overlay panel bruce a.
Your doctor might want to use special tests if it looks like herpetic eye disease might be present. Herpes simplex virus stromal keratitis and endotheliitis. The most common culprits of herpetic eye disease are the herpes simplex. One thing they have in common, however, is that they can both be very painful because they affect the nerves directly. The first thought in most peoples mind is venereal disease, sexual transmitted disease std. A prospective clinical study included 260 subjects. Members of the herpetic eye disease study group are listed in the appendix. Available from national technical information service accession. Ganciclovir gela new topical treatment for herpetic. Clinical manifestations and treatment considerations of herpes simplex virus infection. Herpetic eye disease is common in all age groups, and is often seen in general practice. The herpetic eye disease study focused in part on the.
Hedsrfs is evaluating the effect of psychological, environmental, and biological factors on recurrences of herpetic eye disease. Introduction clinical eye and vision care 7 1995 151154 news and views section the herpetic eye disease study timothy harkins va medical center, 4801 linwood boulevard, kansas city, mo 64128, usa simplex virus hsv keratitis is a serious corneal problem. Herpetic eye disease is a disorder where numerous randomized clinical trials help guide clinicians on how to best care for patients. Medicina free fulltext the role of c21orf91 in herpes. Jan 28, 2011 the herpetic eye disease study group found that using prophylactic oral acyclovir helped to prevent relapses in patients with recurrent herpetic eye disease, but the study group excluded patients. Prior to the hedsi trials, the role of topical corticosteroids in the management of hsv stromal keratitis was uncertain. Herpes zoster ophthalmicus hzo is a disease that occurs when the ophthalmic division of the trigeminal nerve is impaired as a result of reactivation of the varicellazoster virus. The herpetic eye disease study heds from the national eye institute found that the use of oral acyclovir 400 mg po bid or equivalent was effective in 1 significantly reducing the incidence of recurrent epithelial. Herpes simplex virus hsv infection of the eye is a major cause of corneal opacity in the us 1 and other developed countries. Herpetic eye disease study heds i the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Herpes simplex virus is responsible for numerous ocular diseases, the most. Here is a breakdown of key findings that can be directly applied to clinical practice. The herpetic eye disease study heds acyclovir prevention trial apt examined longterm use of oral acyclovir to prevent recurrent hsv disease, and found a 45% reduction 95% ci 0.
Erpes simplex virus hsv is a leading cause of corneal opacification and infectionrelated visual loss. The influence of prednisolone on external eye disease, virus proliferation and latent infection in an animal model of herpes simplex keratitis. Most herpesvirus infections are mild or asymptomatic. Masquerader is the first word that comes to mind for sonal s. 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. Despite the availability of antiviral agents that are effective in treating herpes simplex.