Herpes simplex anterior uveitis

Herpes simplex virus (HSV) is involved in the pathogenesis of many ocular d isorders including blepharitis, conjunctivitis, keratitis, trabeculitis, an terior uveitis, acute retinal necrosis syndrome, retinitis, and optic neuri tis. Ocular HSV is a common infection accounting for 1% to 9% of all cases of uveitis; it is considered to be a leading cause of blindness in industri alized countries. Ocular infections in adults are predominantly due to HSV type 1 (HSV-1); genitoocular spread can occur but is rare. Genital involvem ent is predominantly due to HSV type 2 (HSV-2) and, occasionally, HSV-1. He nce, neonatal infection is usually due to HSV-2 infection. Neonatal central nervous system (CNS) involvement may be associated with chorioretinitis an d keratitis; only 3% of affected neonates have cataracts, which may paralle l the association with uveitis.(1-3) In neonates and infants without CNS in volvement, a keratitis (8%) or conjunctivitis (10%) becomes more important and may be related to postnatal infection with HSV1.(2,3) An intrauterine o r neonatal birth canal infection with HSV can be diagnosed by serum HSV-IgM antibodies within 2 weeks of infection. Visual loss in adults is due to ke ratitis, uveitis, cataract, and glaucoma but, in children, it is more commo nly due to optic atrophy and chorioretinitis.(1-3) Risk factors for HSV reactivation are well-known and include stress, fever, ultraviolet radiation, menstruation, and trauma, including surgical trauma . Bilateral disease is associated with atopy, preexisting diseases that alt er immunity, and immunosuppressive agents. The main objective of this chapter is to study the clinical manifestations and management of herpes simplex anterior uveitis in the absence of active epithelial or stromal keratitis.