Diagnosing and treating herpetic anterior uveitis

Abstract

Human herpes virus infections are a major cause of morbidity worldwide. 1 x 1 Gaynor, B.D., Margolis, T.P., and Cunningham, E.T. Jr. Advances in the diagnosis and management of herpetic uveitis. Int Ophthalmol Clin. 2000; 40: 85–109 Crossref | PubMed | Scopus (23) | Google Scholar See all References 1 Eight distinct herpes viruses have been identified, including six that cause eye disease: herpes simplex viruses 1 and 2 (HSV1, HSV2), varicella zoster virus (VZV), Epstein-Barr virus, cytomegalovirus, and human herpes virus 8, which has been implicated in the pathogenesis of Kaposi’s sarcoma. Of these, HSV 2 x 2 Liesegang, T.J. Classification of herpes simplex virus keratitis and anterior uveitis. ([review])Cornea. 1999; 18: 127–143 Crossref | PubMed | Scopus (120) | Google Scholar See all References 2 and VZV 3 x 3 Liesegang, T.J. Varicella-zoster virus eye disease. Cornea. 1999; 18: 511–531 Crossref | PubMed | Scopus (58) | Google Scholar See all References 3 are by far the most common ocular pathogens, each with an approximate incidence of 10 to 20/100,000 person-years. 4 x 4 Liesegang, T.J., Melton, L.J. III, Daly, P.J., and Ilstrup, D.M. Epidemiology of ocular herpes simplex. Incidence in Rochester, Minn, 1950 through 1982. Arch Ophthalmol. 1989; 107: 1155–1159 Crossref | PubMed | Scopus (220) | Google Scholar See all References , 5 x 5 Liesegang, T.J. Epidemiology of ocular herpes simplex. Natural history in Rochester, Minn, 1950 through 1982. Arch Ophthalmol. 1989; 107: 1160–1165 Crossref | PubMed | Scopus (137) | Google Scholar See all References Clinical presentations of ocular HSV and VZV infections vary considerably but include blepharitis, conjunctivitis, scleritis, keratitis, anterior uveitis, necrotizing retinitis, choroiditis, and optic neuritis. HSV keratitis is the most common cause of corneal blindness in developed countries and second only to trachoma as a cause of corneal blindness in those parts of the developing world where chlamydial conjunctivitis is endemic. Primary VZV infection produces varicella, which is typically a childhood disease resulting in ganglionic latency. Recurrent VZV infection, by contrast, produces herpes zoster and tends to occur more frequently in the elderly. Although the incidence of varicella has decreased dramatically in those areas where childhood VZV vaccination is routine, and early reports suggest a subsequent decline in the rate of herpes zoster in young adults, it will take several decades for the true incidence of herpes zoster to be determined in vaccinated populations. 6 x 6 Prevention of varicella. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 1999;48:1–5. Google Scholar See all References 6