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Oral antiviral prophylaxis should be considered for patients with frequent recurrences of corneal disease


Taking oral antiviral medications following infection with the herpes simplex virus may be associated with a reduced risk of recurring eye-related manifestations of the disease.

Herpes simplex virus ( HSV ) is a common cause of corneal disease and is the leading infectious cause of corneal blindness among developed nations. After the initial exposure to the virus and the resulting systemic infection, herpes simplex establishes a latent infection in sensory nerve structures. Reactivation of this latent infection could lead to initial or recurrent disease in one or both eyes, including inflammation or infection of the cornea, eyelid, membrane inside the eye ( conjunctivitis, or pink eye ) or middle layer of the eye ( uveitis ).

The study estimated the incidence of HSV eye disease in a community-based cohort, in Minnesota, from 1976 through 2007. During this time period, 394 patients with ocular HSV were identified, for an annual incidence of 11.8 per 100,000 individuals.
Oral antiviral therapy was prescribed in 175 ( 44% ) of these patients, who underwent therapy for an average of 2.8 years ( 36% of the average 7.7 years of follow-up ).

Patients not taking this prophylactic therapy were 9.4 times more likely to have a recurrence of epithelial keratitis ( infection of the top layer of the cornea ), 8.4 times more likely to have a recurrence of stromal keratitis ( infection of deeper layers of the cornea ) and 34.5 times more likely to have a recurrence of blepharitis ( eyelid infection ) or conjunctivitis than those taking antiviral medications.
A total of 20 patients experienced adverse outcomes, including visual loss and perforation of the cornea; of these, 17 ( 85% ) were not taking oral antiviral prophylaxis.

This community-based retrospective study demonstrated a stable incidence of HSV eye disease during a recent 32-year period. The researchers found a more dramatic protective effect of oral antiviral prophylaxis on recurrences of ocular HSV than had been described previously.

The results of this study suggest that oral antiviral prophylaxis should be considered for patients with frequent recurrences of corneal disease. Additionally, an evaluation of the possible barriers preventing compliance with antiviral prophylaxis and a reassessment of the cost-effectiveness of long-term oral antiviral therapy are recommended.

Source: Archives of Ophthalmology, 2010

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