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Herpes simplex uveitis.
Bol Asoc Med P R. 2004 Mar-Apr; 96(2):71-4, 77-83.BA

Abstract

BACKGROUND

Uveitis in herpes simplex virus (HSV) ocular disease is usually associated with corneal stromal disease. It has generally been believed that herpetic uveitis in the absence of corneal disease is very rare. When seen it is usually attributed to varicella zoster virus (VZV) infections. The diagnosis of uveitis caused by herpes simplex is often not diagnosed resulting in inadequate treatment and a poor visual result.

METHODS

Seven patients from a large uveitis practice who presented with a clinical picture of: anterior uveitis and sectoral iris atrophy without keratitis, a syndrome highly suggestive of herpetic infection, are reported. Polymerase chain reaction (PCR) was done in the aqueous of four of them and was positive for HSV. One patient had bilateral disease. Most of the patients also had severe secondary glaucoma.

RESULTS

Of the seven patients presented five had no history of any previous corneal disease. Two had a history of previous dendritic keratitis which was not active at the time of uveitis development. One patient with bilateral disease was immunosuppressed at the time when the uveitis developed. Six of the seven patients had elevated intraocular pressures at the time of uveitis and five required glaucoma surgery. Intractable glaucoma developed in two patients leading to rapid and severe visual loss despite aggressive management.

CONCLUSION

Findings suggest that uveitis without corneal involvement may be a more frequent manifestation of ocular herpes simplex disease than previously thought. Absence of corneal involvement delays a correct diagnosis and may worsen visual outcome. Primary herpetic uveitis (when there is no history of previous corneal disease) seems to be more severe than the uveitis in patients with previous corneal recurrences. The associated glaucoma may be a devastating complication.

Authors+Show Affiliations

Department of Ophthalmology University of Puerto Rico School of Medicine.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

15580909

Citation

Santos, Carmen. "Herpes Simplex Uveitis." Boletin De La Asociacion Medica De Puerto Rico, vol. 96, no. 2, 2004, pp. 71-4, 77-83.
Santos C. Herpes simplex uveitis. Bol Asoc Med P R. 2004;96(2):71-4, 77-83.
Santos, C. (2004). Herpes simplex uveitis. Boletin De La Asociacion Medica De Puerto Rico, 96(2), 71-4, 77-83.
Santos C. Herpes Simplex Uveitis. Bol Asoc Med P R. 2004 Mar-Apr;96(2):71-4, 77-83. PubMed PMID: 15580909.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Herpes simplex uveitis. A1 - Santos,Carmen, PY - 2004/12/8/pubmed PY - 2005/2/9/medline PY - 2004/12/8/entrez SP - 71-4, 77-83 JF - Boletin de la Asociacion Medica de Puerto Rico JO - Bol Asoc Med P R VL - 96 IS - 2 N2 - BACKGROUND: Uveitis in herpes simplex virus (HSV) ocular disease is usually associated with corneal stromal disease. It has generally been believed that herpetic uveitis in the absence of corneal disease is very rare. When seen it is usually attributed to varicella zoster virus (VZV) infections. The diagnosis of uveitis caused by herpes simplex is often not diagnosed resulting in inadequate treatment and a poor visual result. METHODS: Seven patients from a large uveitis practice who presented with a clinical picture of: anterior uveitis and sectoral iris atrophy without keratitis, a syndrome highly suggestive of herpetic infection, are reported. Polymerase chain reaction (PCR) was done in the aqueous of four of them and was positive for HSV. One patient had bilateral disease. Most of the patients also had severe secondary glaucoma. RESULTS: Of the seven patients presented five had no history of any previous corneal disease. Two had a history of previous dendritic keratitis which was not active at the time of uveitis development. One patient with bilateral disease was immunosuppressed at the time when the uveitis developed. Six of the seven patients had elevated intraocular pressures at the time of uveitis and five required glaucoma surgery. Intractable glaucoma developed in two patients leading to rapid and severe visual loss despite aggressive management. CONCLUSION: Findings suggest that uveitis without corneal involvement may be a more frequent manifestation of ocular herpes simplex disease than previously thought. Absence of corneal involvement delays a correct diagnosis and may worsen visual outcome. Primary herpetic uveitis (when there is no history of previous corneal disease) seems to be more severe than the uveitis in patients with previous corneal recurrences. The associated glaucoma may be a devastating complication. SN - 0004-4849 UR - https://www.unboundmedicine.com/medline/citation/15580909/Herpes_simplex_uveitis_ L2 - http://www.diseaseinfosearch.org/result/9684 DB - PRIME DP - Unbound Medicine ER -