BACKGROUND: Corticosteroids are commonly used for the treatment of herpes simplex stromal keratitis. However, the treatment of herpes simplex epithelial keratitis with corticosteroids is generally contraindicated. It is well documented that exclusive steroid use in infections of the epithelium by HSV may enhance proliferation of the virus. Subsequently, secondary changes to the stroma along with uveal inflammation can also occur through antigen-antibody reaction or by toxin production. However, there may be scenarios where an active epithelial lesion is accompanied by ocular inflammation requiring both antiviral and anti-inflammatory therapy.
CASE REPORT(S). This poster presents the case of a 66-year-old pseudoexofoliation glaucoma patient who initially presented with bilateral anterior uveitis. She was treated with Pred Forte and subsequently with Vexol for the ocular inflammation. As she was being tapered off the steroid regimen, she acquired HSV epithelial keratitis. Concurrent treatment with Viroptic and Vexol successfully resolved the active viral infection and anterior chamber inflammation.
CONCLUSIONS. The herpetic corneal infection may have been precipitated by the steroid treatment used for the uveitis. Alternatively, the anterior chamber reaction itself may have been a clinical manifestation of HSV although this would seem less likely given the initial absence of either stromal or epithelial disease. The treatment of active HSV dendritic lesions traditionally calls for aggressive use of antivirals and for rapid tapering of any pre-existing steroids. Although use of corticosteroids in HSV epithelial keratitis may lead to geographic ulceration, its judicious use in low doses alongside antiviral therapy may be indicated and effectively utilized to resolve concurrent ocular inflammation.