TREATMENT OF HERPES SIMPLEX KERATITIS

About two thirds of dendritic ulcers respond to instillations of antimetabolites such as idoxuridine (IDU), such treatment being especially valuable for children and for geographic ulcers. If a good response is obtained after five days, treatment should be continued for a total of two weeks. If not, cauterization and removal of the infected and adjacent epithelium should be performed. This latter well-established treatment has certain advantages as a primary treatment, especially in unreliable patients. The complications of IDU therapy are relatively infrequent. Local administration of corticosteroids is contraindicated for dendritic ulcer. Stromal herpes keratitis requires restraint in treatment and patience on the part of the victim. Antimetabolites are ineffective. Cautious administration of corticosteroids is warranted only for severe cases with prolonged keratitis, relatively dense infiltration, early vascularization, and intense iridocyclitis. Unresponsive cases, especially those with deep ulceration and a poor visual prognosis, may require either a lamellar or penetrating corneal transplant. The herpes virus in humans evidently can penetrate the stroma, remain there after apparent healing and produce a direct infection of the iris. Local administration of corticosteroids can increase replication of the virus and spread of infection. © 1969.