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Cornea editor's corner of the world Herpes simplex keratitis (HSV) is one of the most challenging entities that faces ophthalmologists. A geographic ulcer with fluorescein staining of the base of the ulcer and rose bengal staining of the peripheral terminal end bulbs Source: Vincent P.
Herpes ocular infection is one of the leading causes of infectious corneal blindness in the United States and Europe, according to Vincent P.
With these older medications, practitioners were seeing corneal epithelial toxicity in the form of punctate keratitis and even more serious effects.

With the availability of ganciclovir gel, treatment preferences for HSV keratitis are now somewhat in flux. The fact that toxicity is less of a factor makes the decision to use topical therapy alone easier. Topical antivirals have had significant toxicity, and the more recent trend has been to use oral antiviral agents to manage HSV keratitis. Hovanesian finds that because ganciclovir is not toxic to the epithelium, successful healing of HSV keratitis is evident to both the patient and the physician at an earlier stage. Hovanesian pointed out that the new ganciclovir gel, while a real step up for HSV keratitis, is not likely to be a moneymaker for the pharmaceutical company like an antibiotic would be.

I have asked two corneal experts to comment on their approach to HSV keratitis and how, if at all, this new medication has changed their management. However, in doing this he cautions against pushing too deeply with the swab since this could push the viral antigen deeper into the stroma.

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