Anti-glaucoma agents-induced pseudodendritic keratitis presumed to be herpetic simplex keratitis: a clinical case series.

Anti-glaucoma agents-induced corneal toxicity may be misdiagnosed as herpetic simplex keratitis (HSK). In our study, nineteen glaucoma patients were presumed to have HSK before referral. Corneal lesions were classified into (I) linear pseudodendritic lesions formed by elevated opacified cells, (II) linear pseudodendritic lesions formed by grouped superficial punctate keratitis (SPK), (III) satellite full-thickness epithelial defects, (IV) satellite lesions formed by elevated opacified cells, and (V) geographic lesions formed by grouped SPK. We observed thirty-one events, with 15 in the lower and 16 in the central corneas. There were 21 (67.7%) type II, five (16.1%) type V, two (6.5%) of each for types III and IV, and one (3.2%) type I events. Among linear lesions (types I and II), 17 (77.3%) had horizontal and 5 (22.7%) had curvilinear orientations. Exposure duration to the last-added anti-glaucoma agent was three days to 14.5 years. About half of the events (16/31, 51.6%) used prostaglandin analogues, and 30/31 (96.8%) applied benzalkonium chloride (BAK)-containing agents. All lesions resolved within two months after decreasing offending medications or enhancing protection of ocular surface. In conclusion, anti-glaucoma agents-induced pseudodendritic keratitis presents majorly in central-lower cornea as horizontally linear lesions, and BAK-containing agents are observed in the most events.

A community study of ocular herpes simplex.

A recent epidemiologic study of ocular herpes simplex in 151 patients over a 33 year old period in Rochester, Minnesota has challenged some of the clinical and epidemiologic tenets about the disease. The incidence rate for new and recurrent cases and the prevalence rate was calculated and projected to the white U.S. population. The recurrence rate assessed by life table methods were determined for up to 20 years after the first episode and these rates rose following repeated episodes. Previous studies in the same community allow comparison of the incidence rates with other herpetic diseases. This community based study more accurately defines many of the features of the disease such as the prevalence among the sexes, the increasing age at presentation, the frequency of bilateral disease, the relationship of the initial disease to the future recurrence patterns, the frequency of lid, epithelial, stromal, and uveitis in an unselected community population, and the final visual outcome. This data estimates more accurately the morbidity and social impact of the condition.

[An analysis of 1,048 cases of corneal disease].

1,048 cases (1,360 eyes) of corneal disease during 1982 to 1987 with complete records were analyzed. It was found that the ratio of incidences between male and female was about 2:1, and the age was predominantly (66.5%) from 21 to 50 years. The leading blinding corneal disease was herpes simplex keratitis, and bacterial and mycotic infections were mostly associated with trauma. The pathogenesis of marginal keratitis was mainly an autoimmune process, and the high incidence (43.9%) of punctate superficial keratitis was surprising. Corneal disease due to vitamin A deficiency still occurred occasionally in children. The findings indicated that most corneal blindness was preventable through hygienic measures and promotion of general health.

Estudio cooperativo: epidemiología departamento de córnea Hospital del Salvador (ECEDEC) / Cooperative study: epidemiology of the cornea department of Hospital del Salvador (ECEDEC)

Mil cuatrocientas treinta y siete atenciones del Departamento de Córnea del Hospital del Salvador originadas por 640 pacientes en un lapso de 12 meses, fueron analizadas en un trabajo prospectivo. La edad promedio fue de 43,3 años y un 56,9% fueron mujeres. La patología más frecuente fue el herpes simple con un 19,6% de las atenciones. Las patologías que tienen solución quirúrgica consultaron con mayor frecuencia, y fue así como el control de los pacientes con queratoplastías determinó casi 1/3 de todas las atenciones. El 91,5% de las consultas de pacientes citados correspondieron a pacientes antiguos, a pesar de lo cual hubo mucha patología aguda. El sexo femenino consultó mayoritariamente, con especial relevancia en catarata, queratopatía bulosa, rosácea e hipolacrimia y el masculino lo hizo principalmente en patología traumática. La edad jugó un rol relativo en los diferentes cuadros, ajustándose sus promedios a lo esperado. Las distrofias corneales, especialmente las endoteliales, ocuparon el 4- lugar en frecuencia y el 2- en las atenciones por queratoplastías

Epidemiology of ocular herpes simplex. Incidence in Rochester, Minn, 1950 through 1982.

Over the period 1950 through 1982, 122 Rochester, Minn residents had their first episode of ocular herpes simplex virus infection, for an age- and sex-adjusted incidence of 8.4 new cases per 100,000 person-years (95% confidence intervals [CI], 6.9 to 9.9 cases). These initial episodes involved lid or conjunctiva in 54%, superficial cornea in 63%, deeper cornea in 6%, and uveitis in 4%. An additional 29 residents had episodes of ocular herpes other than their first. Altogether, these 151 residents had 294 episodes of ocular herpes simplex infection, for an adjusted incidence of 20.7 episodes per 100,000 person-years (95% CI, 18.3 to 23.1 episodes). Age-adjusted rates by sex were comparable. There were no seasonal trends in incidence, but rates increased with time. On January 1, 1980, the prevalence of a history of ocular herpes simplex infection was 149 per 100,000 population (95% CI, 115 to 183).

Epidemiology of ocular herpes simplex. Natural history in Rochester, Minn, 1950 through 1982.

In the period 1950 through 1982, there were 294 episodes of ocular herpes simplex virus infection in 151 residents of Rochester, Minn. Recurrence rates assessed by life-table methods after the first episode were 9.6% at 1 year, 22.9% at 2 years, and 63.2% at 20 years. Recurrence rates appeared to rise following repeated episodes. Ocular herpes simplex affecting both eyes at the same and/or different episodes was seen in 18 patients (11.9%). One fifth of patients had lid involvement alone, while a third had solely superficial corneal involvement. Deep corneal disease or uveitis was relatively uncommon. Therapy during the early period was varied, but significant complications were uncommon. Ninety percent of the eyes maintained visual acuity of 20/40 or better. The economic impact, measured in terms of days of active disease and physician visits, was substantial.

Exogenous, ocular, and systemic factors associated with keratitic ulceration.

Information on type and frequency of empirically observed exogenous, ocular, and systemic predisposing factors for keratitic ulceration is important for clinical identification of groups at risk and may form a basis for planning experimental studies on the pathogenesis of ulceration. Therefore a retrospective study comprising 104 patients with 25 herpetic and 79 non-herpetic corneal ulcerations was performed. Patients with herpetic ulcerations were mainly males and were younger than patients with non-herpetic corneal ulceration. Keratoplasty and steroid treatment was found as frequent co-existing predisposing factors in the herpetic group. In the non-herpetic group an exogenous factor was found in 56%, an ocular factor in 56%, and a systemic predisposing factor in 46% of the patients. In only 2.5% of these patients was there found no predisposing factor. Pathogenetic mechanisms of predisposing factors for non-herpetic corneal ulceration is discussed.

Hypothetical vaccination of the Dutch population with a herpes simplex virus vaccine: estimation of the profitability using a demographic projection model.

The apparently increasing evidence of herpes simplex virus infections of the genital tract has focused attention on preventing the infection by vaccination. Herpes genitalis is not, however, the most quantitatively important clinical manifestation of herpes simplex virus infections. Because 41% of the hospitalized patients are younger than 20 years, vaccination of birth cohorts would be more favourable. In this paper the financial benefits of a hypothetical herpes simplex virus vaccination were calculated with the use of a population projection model. For the Netherlands, if the price of the hypothetical herpes simplex virus vaccine equals the cost price of the mumps component of the combined mumps-measles-rubella vaccine, the herpes vaccine would be profitable within 8 years.

Recurrent herpes simplex virus ocular infection: epidemiological and clinical features.

The epidemiological and clinical features of recurrent herpes simplex virus ocular infection (RHSV) were studied. Of 108 patients with primary herpes simplex virus ocular infection (PHSV) who were followed up for two to 15 years 35 (32%) suffered one or more recurrent attacks. The recurrence rate was significantly higher in patients under 20 years of age, but there was no significant difference between recurrence rates in males and females. Of 35 patients with RHSV 17 (49%) had one recurrent attack, 14 (40%) had between two and five, and four (11%) had between six and 15 attacks. The mean time interval between PHSV and the first four RHSV attacks was 10 months, and was shorter in subsequent attacks. The duration and severity of RHSV were reduced in successive recurrences. Patients with more severe conjunctivitis and lid lesions during PHSV ocular infection had a higher incidence of recurrent infection. The severity of the corneal signs in PHSV had no influence on the incidence of recurrent infection. Several clinical forms of RHSV were observed. Conjunctivitis associated with lid lesions was observed in 29 (83%) patients. In six (17%) patients the disease presented as an acute follicular conjunctivitis without characteristic lid or corneal lesions. Dendritic ulcer was found in three (9%) patients, and in one of them it was associated with a disciform keratitis. A chronic blepharoconjunctivitis developed in eight (23%) patients. The epidemiological and clinical features of RHSV were compared with those of PHSV.

Epidemiological and clinical features of primary herpes simplex virus ocular infection.

The epidemiological and clinical features of primary herpes simplex virus ocular infection in 108 patients were studied. Of these, 69 (64%) were aged 15 or over and only eight (7%) were under the age of 5. Associated upper respiratory tract infection was found in 38 (35%) patients and systemic disorders such as mild malaise, fever, and aching in 34 (31%) patients. Common symptoms were redness, watering, discharge, itching, irritation, and lid swelling, whereas pain, photophobia, lid vesicles and ulcers, and blurred vision were less frequent. The major signs consisted of vesicles and ulcers on the lids, papillary responses which were more severe in the upper lid conjunctiva, follicles which were more common in the lower lid conjunctiva, fine and coarse epithelial punctate keratitis, and subepithelial punctate keratitis. Dendritic ulcers and disciform keratitis were found in 16 (15%) and two (2%) patients respectively. The clinical forms of primary herpes simplex virus ocular infection varied. Moderate or severe disease was observed in 41 (38%) and 16 (15%) patients respectively. In eight (7%) patients the disease presented as an acute follicular conjunctivitis without characteristic lid or corneal lesions. A chronic blepharoconjunctivitis which lasted for months developed in 16 (15%) patients. The epidemiological and clinical features in our patients were compared with features of the disease reported previously.

The acute retinal necrosis syndrome. Possible herpes simplex retinitis.

The acute retinal necrosis (ARN) syndrome is a severe necrotic peripheral retinitis with vasculitis and vitritis. It attacks healthy people and carries a poor visual prognosis. Five patients with ARN were seen. Two showed interesting clinical features. One patient developed the ARN syndrome in both eyes but with a 14-year hiatus separating the two episodes, each being preceded by an infectious illness. A second patient had a possible recurrence of the ARN syndrome in the same eye, one year after the original episode. Each episode was preceded by an upper respiratory infection and ipsilateral vesicular skin lesions on the face. Biopsy of one lesion yielded herpes simplex virus (HSV) in culture. These associations, although not definitive, do lend support to the hypothesis that HSV may be the cause of the ARN syndrome.

Prevalence of acute conjunctivitis caused by chlamydia, adenovirus, and herpes simplex virus in an ophthalmic casualty department.

The causes of acute conjunctivitis in 140 consecutive patients attending an ophthalmic casualty department in London were investigated. Laboratory evidence of infection with Chlamydia trachomatis, adenovirus, or herpes simplex virus was found in 52 (37%) cases. In 70 cases (50%) no evidence of infection with these agents was found. In the remaining 18 cases (13%) laboratory results were inconclusive. The importance of these findings, the role of laboratory investigations in the differential diagnosis of acute conjunctivitis, and their cost-benefit are discussed.

The epidemiology and clinical presentation of herpes virus infections.

The chief characters of infection by the human herpes viruses are considered with particular reference to herpes simplex viruses, types 1 and 2. Infection with type 1 virus is acquired very early in life though infrequently as a true congenital transmission of virus. Primary infections result from direct contact usually with infected saliva or skin vesicles. Kerato-conjunctivitis, when primary, may be severe yet superficial in extent. Vulvo-vaginitis, often acquired in adults as a result of type 2 infection by sexual transmission, can give extensive but superficial ulceration and discharge. Recurrent infections located on the dermatome with the same nerve supply as that of the organ affected primarily occur throughout life and at relatively short intervals. Sensory nerve ganglia harbour the virus particles as latent infection and when reactivation occurs virus spreads along nerve fibres to the skin. The most serious infections occur as disseminated disease with liver involvement in the neonatal period, in infants suffering from malnutrition or those undergoing immunosuppression for malignancies. Eczematous children are then at particular risk from spreading haemorrhagic skin lesions (Kaposi's eruption). Herpes encephalitis, commoner in adults than children, is an insidious severe disease with mortality related to the depth of coma. Antiviral therapy though successful may lead to chronic neurological sequelae. The success of antiviral therapy in herpes partly turns on the ability to bring the drug into close contact with the infected tissues. Latent virus is relatively unaffected by acyclovir and thus far recurrences have continued to occur.

[Evaluation of 80 virologically-confirmed cases of ocular herpes. Study of the correlation between the type of virus and the epidemiologic characteristics of the disease]. / Bilan de 80 cas d'herpès oculaire virologiquement confirmés. Etude des corrélations entre le typage du virus et les caractères épidémiologiques de la maladie.

80 strains were isolated from patients with herpetic ocular infection during the period May 1979 to May 1981: 17 patients with herpetic blepharitis, 40 patients with superficial keratitis and 23 with deep stromal keratitis or kerato-uveitis. Among 63 patients treated with antiviral agents, clinical resistance to the drug was observed in 17 cases. The strains were typed as HSV 1.1, 1.2 or 2.2 by seroneutralization and thermosensitivity in cellular cultures. No relationship between the viral types and the patient age, previous history of corticosteroid therapy and the response of ocular lesions to antiviral treatment were detected. It appeared that there was a relationship between the viral type and the clinical type of infection: 70% of herpetic blepharitis and 83% of superficial keratitis were due to HSV 1.1 while 71% of stromal keratitis were due to HSV 1.2. No HSV 2.2 was isolated. These results seem to support the hypothesis that genetic differences between herpetic virus strains may determine their virulence.