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25 Herpetic keratitis is the most common cause of corneal blindness, and is considered to be a major indication for penetrating keratoplasty (PKP). 1 Herpetic keratitis is caused by human herpes virus (HHV). Table 1 shows the herpes viruses that may cause disease in man. 2–5 Certain viral infections have been eradicated by vaccination, and others are controlled by public health measures. The resilience of viruses has led to the emergence of new viruses and the evolution of old viruses causing potentially blinding diseases of the eye. HHV type 1 (HHV-1) is endemic worldwide and humans are the only known natural reservoir for the virus. By age 60, approximately 95% of individuals are infected by HHV-1. HHV-1 is transmitted by direct contact with infected secretions such as saliva or tears or coming in contact with cutaneous lesions infected by HHV-1.There are approximately one million cases of new ocular herpetic infections annually worldwide. Patients make an average of four visits to the ophthalmologist for the first episode and six visits for recurring episodes of herpetic keratitis. 6–10 It is estimated that close to two-thirds of all cases of primary herpes infections are asymptomatic. Initial exposure to HHV leads to primary infection. The virus becomes latent in the nerve ganglia and approximately 98% of patients with herpes infection shed HHV-1 genome in tears or saliva. 11 Following a primary infection, the virus stays latent in the sensory and autonomic neurons of ganglia (trigeminal ganglion, ciliary ganglion, superior cervical ganglion). The recurrences (secondary infection) of herpetic lesions are the result of reactivation of the virus. 6,12,13 The reactivation leads to shedding of the virus or recurrence of the disease. There are risk factors both genetic and environmental that lead to reactivation. The clinical manifestations depend on the site of latency. Infection with HHV is determined by local susceptibility, general host immunity, the virus strain, and genetic predisposition. 14 The site of viral latency determines the future of reactivation and clinical manifestations of the disease. Latency of HHV in the trigeminal ganglion may lead to recurrence of herpetic keratitis. There are 25 different types of neurons in the trigeminal ganglion. Latency in the superior cervical ganglion may lead to reactivation and recurrence of herpetic intraocular inflammation and anterior uveitis. Latency in the ciliary ganglion may lead to recurrent intraocular inflammation. Alpha adrenergic compounds and estradiol may lead to the reactivation of HHV from the …

Topical Ganciclovir in Herpetic Eye Disease