Clinical Management of Herpes Simplex Virus Keratitis

Abstract

Herpes simplex virus (HSV) keratitis is one of the leading causes of blindness worldwide. Additionally, up to 90% of the population in some countries is seropositive for HSV. HSV can cause a wide spectrum of ocular disease ranging from blepharitis to retinitis. Although the initial clinical expressions of HSV-1 and HSV-2 are similar, HSV-2 has been reported more frequently in association with recurrent HSV disease. Besides irreversible vision loss from keratitis, HSV also causes encephalitis and genital forms of the disease. Despite these statistics, there remains no vaccine against HSV. Current treatment therapies for related ocular diseases include the use of oral and topical antivirals and topical corticosteroids. While effective in many cases, they fail to address the latency and elimination of the virus, making it ineffective in addressing recurrences, a factor which increases the risk of vision loss. As such, there is a need for continued research of other potential therapeutic targets. This review utilized several published articles regarding the manifestations of HSV keratitis, antiviral immune responses to HSV infection, and clinical management of HSV keratitis. This review will summarize the current knowledge on the host–virus interaction in HSV infections, as well as highlighting the current and potential antiviral therapeutics.

Exploring Heparanase Levels in Tears: Insights From Herpes Simplex Virus-1 Keratitis Patients and Animal Studies

“…All patients were managed as per the standard treatment protocol for the management of HSV-1 keratitis. 23 The clinically identified corneal signs for the study cohort are described in Supplementary File S1 .…”

Herpes simplex keratitis: A brief clinical overview

“…After initial infection with HSV, hosts carry the infection for life[ 41 - 43 ]. Transmission generally is by direct contact of the skin or mucous membranes with lesions or secretions bearing virions[ 44 , 45 ]. HSV is generally divided into two which include HSV-1 and HSV-2[ 46 , 47 ].…”

L-lysine as a Possible Supplement for Treatment of Herpetic Epithelial Keratitis: A Case Report and Literature Review

“…9,16, 17 Although current antivirals are still viable treatments for active herpetic diseases such as keratitis, controlling recurrence and the virus in the latent phase remains a challenge due to a virus in its latent state being resistant to all antiviral drugs. 14, [16][17][18] Vaccines targeting this viral group have not yet been developed, which increases the need for effective therapies that not only safely treat active herpesvirus infection, but also aim to prevent latent infection. Understanding the pathogenesis and virulence characteristics of herpesviruses can lead to new therapeutic targets to prevent the virus from entering, spreading and replicating.…”

“…Understanding the pathogenesis and virulence characteristics of herpesviruses can lead to new therapeutic targets to prevent the virus from entering, spreading and replicating. 18 Genetic engineering is also striving for herpesvirus control, with one promising direction being the development of CRISPR/ Cas systems for safe and relatively effective long-term control of HSV-1 infection. Plasmids encoding the CRISPR/Cas9 system from Streptococcus pyogenes can completely suppress HSV-1 infection in Vero cell lines within 6 days and provide substantial protection within nine days.…”