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Editorial |

The Role of Antiviral Therapy After the Resolution of Acute Herpes Simplex Keratitis or Acute Herpes Zoster Ophthalmicus

Keith H. Baratz, MD
Arch Ophthalmol. 2012;130(1):108-110. doi:10.1001/archophthalmol.2011.379.
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The herpes simplex virus (HSV) and the varicella-zoster virus are important causes of ocular disease. It is well established that topical and oral antiviral medications speed the healing of acute dendritic or geographic epithelial lesions due to HSV,1 and that oral antiviral drugs alter the course of acute varicella-zoster virus eye disease.2 After the resolution of acute disease, some clinical scenarios warrant ongoing antiviral therapy. Establishing clear indications for ongoing treatment is a complex task. The purpose of this editorial is to summarize previous research and newer research in order to provide some basis for rational decision making in the treatment of patients with these often-complex conditions.

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Figure 1. Kaplan-Meier estimates of the risk of recurrence of herpes simplex virus (HSV) ocular disease, illustrating time to first recurrence of HSV ocular disease after an initial episode of the disease (solid line) and time to second recurrence after a first recurrence of HSV ocular disease (dashed line). The time to a third recurrence is nearly identical to that after a second recurrence of HSV ocular disease (adapted from a figure in Young et al4).

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Figure 2. Late mucous plaque keratopathy, unstained. These lesions appeared 8 months after acute herpes zoster ophthalmicus was identified in a 54-year-old man, and a swab specimen of the lesions revealed varicella-zoster virus DNA by the use of polymerase chain reaction techniques. The condition resolved after treatment with oral antiviral medication.

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