Advances in the Management of Ocular Herpetic Disease

Herpes simplex keratitis remains a significant cause of blindness and a leading indication for corneal transplant. Even relatively moderate cases can prove extremely painful and lead to corneal scarring. In patients with latent herpes simplex type 1, a number of ophthalmic procedures and medications are known to create a predisposition to ocular outbreaks. Moreover, each recurrence increases the risk of sight-threatening complications.

Despite these factors, leading herpes keratitis experts have noted a significant educational gap among ophthalmologists in terms of their ability to proactively identify patients with prior history of ocular herpes. Another educational gap exists pertaining to the emerging standard of care that calls for lifelong prophylaxis for patients who experience two or more occurrences of herpes keratitis.

This CME activity provides diagnostic information and educates ophthalmologists about perioperative and/or lifelong prophylaxis in patients with a history of herpes keratitis.

Off-label Use Statement: This work discusses off-label uses of antiinfective medications.

Learning Objectives:

• List the agents currently available for the prevention of herpes keratitis outbreaks associated with ocular surgery and state the advantages and disadvantages of each.
• Compare and contrast oral vs topical administration of antiviral medication for prevention of ocular HSV1 recurrences.
• List the factors believed to trigger ocular HSV1 recurrences and state prophylactic options appropriate to each.
• Discuss available options for the treatment of ocular infection with adenovirus and varicellazoster virus.

Faculty:
Research Perspective: Deborah Pavan-Langston, MD, FACS
Clinical Perspective: Terry Kim, MD and Victor Chang, MD
Historical Perspective: Herbert E. Kaufman, MD

Faculty Advisor: Michael B. Raizman, MD