Decreasing the Risk of Vision Loss in Herpes Simplex Patients

The use of oral antiviral medications in patients with herpes simplex virus (HSV) appears to help decrease the risk of recurrence of epithelial keratitis, stromal keratitis, conjunctivitis, and blepharitis, and may decrease the risk of vision loss in these patients, according to a retrospective study conducted by Young et al from Mayo Clinic, Minnesota. The results of the study were published in a 2010 issue of the Archives of Ophthalmology.

In the study, researchers reviewed the outcomes of 394 residents of Olmsted County, Minnesota, diagnosed with ocular HSV from 1976 through 2007, and compared the frequency of recurrence and adverse outcomes such as vision loss or need for surgery, among patients treated prophylactically with oral antiviral medication and those who did not receive oral antiviral medication. According to their data, the authors found that patients who were not being treated prophylactically were
- 9.4 x more likely to have a recurrence of epithelial keratitis
- 8.4 x more likely to have a recurrence of stromal keratitis
- 34.5 x more likely to have a recurrence of blepharitis or conjunctivitis

Of the 20 patients included the study who experienced adverse outcomes, 17 were not being treated with oral antiviral medications immediately prior to the adverse event.

HSV is a common cause of corneal disease, and recurrence is relatively common. Following initial exposure and primary systemic infection, HSV establishes a latent infection in the trigeminal or other sensory ganglia, disease may recur in one or both eyes, with the risk of recurrence significantly increasing over time. The cumulative effect of these reactivations may lead to stromal inflammation or neurotrophic keratitis, resulting in scar of perforation, the authors noted.

"The results of this study suggest that oral antiviral prophylaxis should be considered for patients with frequent recurrences of corneal disease," the authors concluded. "Additionally, we recommend an evaluation of possible barriers preventing compliance with antiviral prophylaxis and a reassessment of the cost-effectiveness of long-term oral antiviral therapy."