OVERVIEW

INTRODUCTION
  1. Guess S, Stone DU, Chodosh J. Evidence-based treatment of herpes simplex virus keratitis: a systematic review. Ocul Surf. 2007;5:240-50.
  2. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database of Systematic Reviews 2010, Issue 12.

ABOUT HSK
  1. Toma HS, Murina AT, Areaux RG Jr, et al. Ocular HSV-1 latency, reactivation and recurrent disease. Semin Ophthalmol. 2008;23:249-273.
  2. Liesegang TJ. Herpes simplex virus epidemiology and ocular importance. Cornea. 2001;20:1-13.
  3. Young RC, Hodge DO, Liesegang TJ, Baratz KH. Incidence, recurrence, and outcomes of herpes simplex virus eye disease in Olmsted County, Minnesota, 1976-2007: the effect of oral antiviral prophylaxis. Arch Ophthalmol. 2010;128:1178-1183.

ALGORITHM

IS IT A HERPETIC DENDRITE?
Description
  1. Kim T, Chang V. Part two: the clinical perspective: Advances in the management of ocular herpetic disease. Candeo Clinical/Science Communications. 2011:10-15.
  2. Dawson CR, Togni B. Herpes simplex eye infections: clinical manifestations, pathogenesis and management. Surv Ophthalmol. 1976;21:1221-35.
  3. Guess S, Stone DU, Chodosh J. Evidence-based treatment of herpes simplex virus keratitis: a systematic review. Ocul Surf. 2007;5:240-250.
  4. Taylor PB, Tabbara KF. Peripheral corneal infections . Int Ophthalmol Clin. 1986;26:29-48.

DO I NEED TO CONFIRM THE DIAGNOSIS?
Value of Culture and PCR
  1. Taylor PB, Tabbara KF. Peripheral corneal infections. Int Ophthalmol Clin. 1986;26:29-48.
  2. Seitzman GD, Cevallos V, Margolis TP. Rose bengal and lissamine green inhibit detection of herpes simplex virus by PCR. Am J Ophthalmol. 2006;141:756-8.

AM I CONSIDERING ADJUNCTIVE DEBRIDEMENT?
Optional Adjunctive Treatment: Debridement
  1. Wilhelmus KR. The treatment of herpes simplex virus epithelial keratitis. Tr Am Ophth Soc. 2000;98:505-32.
  2. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database of Systematic Reviews 2010, Issue 12.

RECOMMENDED TREATMENT
Zirgan® (ganciclovir ophthalmic gel) 0.15% Dosing and follow-up
  1. Zirgan (ganciclovir ophthalmic gel) 0.15% prescribing information. Tampa, FL: Bausch & Lomb, Inc; 2010.
Alternative Treatment Options
  1. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database of Systematic Reviews 2010, Issue 12.
  2. Kaufman HE. Part three: the historical perspective. Advances in the management of ocular herpetic disease. Candeo Clinical/Science Communications. 2011;16-18.
  3. Viroptic Ophthalmic Solution, 1% Sterile (trifluridine ophthalmic solution) Archived Drug Label. Available at: http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=7007. Accessed on 9/4/12.
  4. Collum LMT, McGettrick M, Akhtar J, et al. Oral acyclovir (Zovirax) in herpes simplex dendritic corneal ulceration. Br J Ophthalmol. 1986;70:435-8.

Adjunctive Treatment Options
  1. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database of Systematic Reviews. 2010, Issue 12.

TREATMENT OUTCOMES
Improved
  1. Zirgan (ganciclovir ophthalmic gel) 0.15% prescribing information. Tampa, FL: Bausch & Lomb, Inc; 2010.

Healed
  1. Zirgan (ganciclovir ophthalmic gel) 0.15% prescribing information. Tampa, FL: Bausch & Lomb, Inc; 2010.

DIAGNOSIS

CLINICAL PRESENTATION
Overview
  1. Guess S, Stone DU, Chodosh J. Evidence-based treatment of herpes simplex virus keratitis: a systematic review. Ocul Surf. 2007;5:240-50.

Clinical Presentation
  1. Al-Dujaili LJ, Clerkin PP, Clement C, et al. Ocular herpes simplex virus: how are latency, reactivation, recurrent disease and therapy interrelated? Future Microbiol. 2011;6:877-907.
  2. Pavan-Langston D. Diagnosis and management of herpes simplex ocular infection. Int Ophthalmol Clin. 1975;15:19-35.
  3. Usatine RP, Tinitigan R. Nongenital herpes simplex virus. Am Fam Physician. 2010;82:1075-82.
  4. Guess S, Stone DU, Chodosh J. Evidence-based treatment of herpes simplex virus keratitis: a systematic review. Ocul Surf. 2007;5:240-50.
  5. Taylor PB, Tabbara KF. Peripheral corneal infections. Int Ophthalmol Clin. 1986;26:29-48.
  6. Liesegang TJ. Herpes simplex virus epidemiology and ocular importance. Cornea. 2001;20:1-13.
  7. Souza PM, Holland EJ, Huang AJ. Bilateral herpetic keratoconjunctivitis. Ophthalmology. 2003;110:493-6.

Clinical History
  1. Liesegang TJ. Herpes simplex virus epidemiology and ocular importance.Cornea. 2001;20:1-13
  2. Toma HS, Murina AT, Areaux RG Jr, et al. Ocular HSV-1 latency, reactivation and recurrent disease.Semin Ophthalmol. 2008;23:249-273.

Clinical Appearance
  1. Dawson CR, Togni B. Herpes simplex eye infections: clinical manifestations, pathogenesis and management. Surv Ophthalmol. 1976;21:1221-35.
  2. Uchio E. Takeuchi S, Itoh N, Matsuura N, Ohno S, Koki A. Clinical and epidemiological features of acute follicular conjunctivitis with special reference to that caused by herpes simplex virus type 1. Br J Ophthalmol. 2000;84:968-72.
  3. Kim T, Chang V. Part two: the clinical perspective: Advances in the management of ocular herpetic disease. Candeo Clinical/Science Communications. 2011:10-15.
  4. Guess S, Stone DU, Chodosh J. Evidence-based treatment of herpes simplex virus keratitis: a systematic review. Ocul Surf. 2007;5:240-50.

Corneal Appearance
  1. Kim T, Chang V. Part two: the clinical perspective: Advances in the management of ocular herpetic disease. Candeo Clinical/Science Communications. 2011:10.
  2. Guess S, Stone DU, Chodosh J. Evidence-based treatment of herpes simplex virus keratitis: a systematic review Ocul Surf. 2007;5:240-50.
  3. Dawson CR, Togni B. Herpes simplex eye infections: clinical manifestations, pathogenesis and management. Surv Ophthalmol. 1976;21:1221-35.
  4. Taylor PB, Tabbara KF. Peripheral corneal infections. Int Ophthalmol Clin. 1986. 26: 29-48.

Stains
  1. Kim J. The use of vital dyes in corneal disease. Curr Opin Ophthalmol. 2000;11:241-7.
  2. Seitzman GD, Cevallos V, Margolis TP. Rose bengal and lissamine green inhibit detection of herpes simplex virus by PCR. Am J Ophthalmol. 2006;141:756-8.

DIFFERENTIAL DIAGNOSIS
Overview
  1. Pavan-Langston D. Diagnosis and management of herpes simplex ocular infection. Int Ophthalmol Clin. 1975;15:19-35.
  2. Taylor PB, Tabbara KF. Peripheral corneal infections. Int Ophthalmol Clin. 1986;26:29-48.
  3. Garg P. Fungal, mycobacterial, and nocardia infections and the eye: an update. Eye. 2012;26:245-51.

VZV
  1. Pavan-Langston DR. Herpes Zoster: Antivirals and pain management. Ophthalmology. 2008;115:S13-20.
  2. Ta CN. The changing epidemiology of ocular shingles. Topics in Ocular Antiinfectives. 2011;16:5-7.

VZV Keratitis
  1. Liesegang TJ. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Ophthalmology 2008;115(2 Suppl):S3-12.

Key Differentiators
  1. Liesegang TJ. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Ophthalmology. 2008;115(2 Suppl):S3-12.
  2. Ta CN. The changing epidemiology of ocular shingles. Topics in Ocular Antiinfectives. 2011;16:5-7.

Acanthamoeba
  1. Joslin CE, Tu EY, Shoff ME, et al. The association of contact lens solution use and Acanthamoeba keratitis. Am J Ophthalmol. 2007;144:169-80.

Other Conditions
  1. Pavan-Langston D. Part one: the research perspective. Advances in the management of ocular herpetic disease. Candeo Clinical/Science Communications. 2011;1-9..
  2. Kandori M, Inoue T, Takamatsu F, et al. Prevalence and features of keratitis with quantitative polymerase chain reaction positive for cytomegalovirus. Ophthalmology. 2010;117:216-22.
  3. Matoba AY. Ocular disease associated with Epstein-Barr virus infection. Surv Ophthalmol. 1990;35(2):145-50.
  4. Pavan-Langston D. Diagnosis and management of herpes simplex ocular infection. Int Ophthalmol Clin. 1975;15:19-35.
  5. Stern GA, Killingsworth DW. Complications of topical antimicrobial agents. Int Ophthalmol Clin. 1989;29:137-42.

LABORATORY EVALUATION
  1. Guess S, Stone DU, Chodosh J. Evidence-based treatment of herpes simplex virus keratitis: a systematic review. Ocul Surf. 2007;5:240-50.

Direct Visualization
  1. Taylor PB, Tabbara KF. Peripheral corneal infections. Int Ophthalmol Clin. 1986;26:29-48.
  2. Dawson CR, Togni B. Herpes simplex eye infections: clinical manifestations, pathogenesis and management. Surv Ophthalmol. 1976;21:1221-35.

Viral Culture
  1. Lab Diagnostic Testing: Herpes simplex virus. Available at: http://eyemicrobiology.upmc.com/Herpes.htm accessed on August 23, 2012.
  2. Taylor PB, Tabbara KF. Peripheral corneal infections. Int Ophthalmol Clin. 1986;26:29-48.
  3. Seitzman GD, Cevallos V, Margolis TP. Rose bengal and lissamine green inhibit detection of herpes simplex virus by PCR. Am J Ophthalmol. 2006;141:756-8.
  4. Kowalski RP, Thompson PP, Cronin TH. Cell culture isolation can miss the laboratory diagnosis of HSV ocular infection. Int J Ophthalmol. 2010;3:164-7.
  5. Stabell EC, O’Rourke SR, Storch GA, Olivo PD. Evaluation of a genetically engineered cell line and a histochemical beta-galactisidase assay to detect herpes simplex virus in clinical specimens. J Clin Microbiol.1993;31:2796-8.
  6. Patel N, Kauffmann L, Baniewicz G, Forman M, Evans M, Scholl D. Confirmation of low-titer, herpes simplex virus-positive specimen results by the enzyme-linked virus-inducible system (ELVIS) using PCR and repeat testing. J Clin Microbiol. 1999;37:3986-9.
  7. Turchek BM, Huang YT. Evaluation of ELVIS HSV ID/typing system for the detection and typing of herpes simplex virus from clinical specimens. J Clin Virol. 1999;12:65-9.
  8. LaRocco MT. Evaluation of an enzyme-linked viral inducible system for the rapid detection of herpes simplex virus. Eur J Clin Microbial Infect Dis. 2000;19:233-5.
  9. Crist GA, Langer JM, Woods GL, Procter M, Hillyard DR.Evaluation of the ELVIS plate method for the detection and typing of herpes simplex virus in clinical specimens. Diagnos Microbiol Infect Dis.2004;49:173-7.

DNA Detection
  1. Kowalski RP, Thompson PP, Cronin TH. Cell culture isolation can miss the laboratory diagnosis of HSV ocular infection. Int J Ophthalmol. 2010;3:164-7.
  2. Thompson PP, Kowalski RP. A 13-year retrospective review of polymerase chain reaction testing for infectious agents from ocular samples. Ophthalmol. 2011;118:1449-53.

TREATMENT

RECOMMENDED TREATMENT
Recommended: Zirgan
  1. Zirgan (ganciclovir ophthalmic gel 0.15%) prescribing information. Tampa, FL: Bausch & Lomb, Inc;2010.
  2. Villarreal EC. Current and potential therapies for the treatment of herpes-virus infections. Prog Drug Res. 2003;60:263-307.
  3. Colin J. Ganciclovir ophthalmic gel, 0.15%: a valuable tool for treating ocular herpes. Clin Ophthalmol. 2007;1(4):441-53.
  4. Zirgan (ganciclovir ophthalmic gel) 0.15% NDA application no. 22-211. Center for drug evaluation and research, medical review. Letter date: November 14, 2008.
  5. Tosti A, Tosti G. Thimerosal: a hidden allergen in ophthalmology. Contact Dermatitis. 1988;18:268-73.
  6. Tripathi BJ, Tripathi RC, Kolli SP. Cytotoxicity ophthalmic preservatives on human corneal epithelium. Lens Eye Toxic Res. 1992;9:361-75.
  7. Foster CS. Ganciclovir gel—a new topical treatment for herpetic keratitis. US Ophthalmic Review. 2008;3:52-6.

Indication
  1. Zirgan (ganciclovir ophthalmic gel 0.15%) prescribing information. Tampa, FL: Bausch & Lomb, Inc; 2010.

Regimen
  1. Zirgan (ganciclovir ophthalmic gel 0.15%) prescribing information. Tampa, FL: Bausch & Lomb, Inc; 2010.

Follow-Up
  1. Zirgan (ganciclovir ophthalmic gel 0.15%) prescribing information. Tampa, FL: Bausch & Lomb, Inc; 2010.

ALTERNATIVE
  1. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database of Systematic Reviews 2010, Issue 12.
Trifluridine
  1. Viroptic Ophthalmic Solution, 1% Sterile (trifluridine ophthalmic solution) Archived Drug Label. Available at: http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=7007. Accessed on 9/4/12.
  2. Kaufman HE. Part three: the historical perspective. Advances in the management of ocular herpetic disease. Candeo Clinical/Science Communications. 2011;16-18.

Oral
  1. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database of Systematic Reviews 2010, Issue 12. Collum LMT, McGettrick M, Akhtar J, et al. Oral acyclovir (Zovirax) in herpes simplex dendritic corneal ulceration. Br J Ophthalmol. 1986;70:435-8.
ADJUNCTIVE
  1. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database of Systematic Reviews 2010, Issue 12.
Debridement
  1. Wilhelmus KR. The treatment of herpes simplex virus epithelial keratitis. Tr Am Ophth Soc. 2000;98:505-32.
  2. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database of Systematic Reviews 2010, Issue 12.

Oral
  1. Guess S, Stone DU, Chodosh J. Evidence-based treatment of herpes simplex virus keratitis: a systematic review. Ocul Surf. 2007;5:240-250.
  2. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database of Systematic Reviews 2010, Issue 12.

Antiviral Resistance
  1. Piret J. Boivin G. Resistance of herpes simplex viruses to nucleoside analogues: mechanisms, prevalence, and management. Antimicrobiol Agents Chemother. 2011;55:459-72.
  2. Duan R, de Vries RD, Osterhuas ADME, Remeijer L, Verjans GMGM. Acyclovir-resistant corneal HSV-1 isolates from patients with herpetic keratitis. J Infect Dis. 2008;198:659-63.
  3. Bacon TH, Levin MJ, Leary JJ, Sarisky RT, Sutton D. Herpes simplex virus resistance to acyclovir and penciclovir after two decades of antiviral therapy. Clin Microbiol Rev. 2003;16:114-28.
  4. Duan R, de Vries RD, van Dun JM, et al. Acyclovir susceptibility and genetic characteristics of sequential herpes virus type 1 corneal isolates from patients with recurrent herpetic keratitis. J Infect Dis.2009;200:1402-14.
  5. Croxtall JD. Ganciclovir ophthalmic gel 0.15%: in acute herpetic keratitis (dendritic ulcers). Drugs. 2011;71:603-10.
 

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