Ocular herpes simplex

These drug are contraindicated in individuals with known hypersensitivity to an individual drug or any components of the drug. The NSA.ID flurbiprofen is contraindicated in patients with herpes simplex keratitis. Diclofenac and ketorolac are contraindicated in patients who wear soft contact lenses (may cause ocular irritation). 

Betamethasone, as with all steroids, is used to suppress inflammatory reactions. It can be used topically or systemically. Indications for its use include eczema, asthma and congenital adrenal hyperplasia. It is contraindicated in ocular herpes simplex and in the red eye syndrome since it may clear the symptoms while not addressing the infective component of the underlying condition. 

Use with caution in patients with active or quiescent tuberculosis infections of the respiratory tract, or in untreated fungal, bacterial, or systemic viral infections, or ocular herpes simplex. 

Acute epithelial herpes simplex keratitis (dendritic keratitis) fungal diseases of ocular structures vaccinia, varicella and most other viral diseases of the cornea and conjunctiva ocular tuberculosis hypersensitivity after uncomplicated removal of a superficial corneal foreign body mycobacterial eye infection acute, purulent, untreated eye infections that may be masked or enhanced by the presence of steroids. 

Hypersensitivity to any component of these products epithelial herpes simplex keratitis (dendritic keratitis) vaccinia varicella mycobacterial infections of the eye fungal diseases of the ocular structure use of steroid combinations after uncomplicated removal of a corneal foreign body. 

Contraindications Hypersensitivity to ciprofloxacin or other quinolones for ophthalmic administration vaccinia, varicella, epithelial herpes simplex, keratitis, mycobacterial infection, fungal disease of ocular structure, use after uncomplicated removal of a foreign body... 

Herpes simplex virus ocular infections-. Ophthalmic 1 drop onto cornea q2h while awake. Maximum 9 drops/day. Continue until corneal ulcer has completely reepithe-lialized then, 1 drop q4h while awake (minimum 5 drops/day) for an additional 7 days. 

Use with caution in patients with hypothyroidism, cirrhosis, ocular herpes simplex, hypertension, congestive heart failure, and ulcerative colitis Psychologic derangements may occur while on therapy... 

Uchoa UBC, Rezende RA, Carrasco MA, et al. Long-term acyclovir use to prevent recurrent ocular herpes simplex infection. Arch Ophthalmol 2003 121(12) 1702-1704. 

Polymer-based artificial tears are the most common tear supplementation product used in dry eye treatment. In addition to dry eye, ocular lubricants are used in the treatment of corneal abrasions, ultraviolet keratitis, herpes simplex and zoster keratitis, phlyctenular disease, giant papillary conjunctivitis, superior limbic keratoconjimc-tivitis, vernal disease, adenoviral infections, and other ocular surfece conditions. 

Herpes simplex virus (HSV), the most common virus found in humans, and VZV have both been known to cause serious ocular complications. Generally speaking, primary disease occurs as a blepharoconjunctivitis in HSV and as chickenpox in VZV but may recur in older children and adults. Both viruses typically manifest as a unilateral ocular disease. 

Liesegang TJ. Herpes simplex virus epidemiology and ocular importance. Cornea 2001 20 1-13. 

Adenovirus and herpes simplex virus (HSV) are the most common causes of viral conjunctivitis. The frequency of infection by one of these organisms varies depending on the particular region s climate and other environmental factors. Box 25-1 summarizes the most significant ocular infectious agents. 

There are many other causes of RCE, but they occur much less frequently. Among these causes are chemical or thermal burns, herpes simplex keratitis, neuroparalytic keratitis, bullous keratopathy, severe dry eyes, nocturnal lagophthalmos, diabetes mellitus, meibomian gland dysfunction, ocular rosacea, and Alport syndrome. Approximately 5% to 30% of RCEs occur spontaneously without any known predisposing fector. 

The virus remains latent in the trigeminal nerve, may remain in the cornea, and has been reported in tears. HSV type 2 usually infects the genital area and is transmitted sexually but can cause ocular infection if transmitted to the eye via infected genital secretions. This most commonly occurs in neonates who are exposed to the virus in the birth canal. In neonates, herpes simplex can cause a fatal systemic infection. 

Herpes simplex keratitis (HSK) is caused by HSV type 1 in adults and is one of the most common infectious etiologies of blindness. It is second only to trauma as a cause of corneal blindness in the United States, where an estimated 50,000 new or recurrent cases are seen each year. Recurrent HSK can be reactivated by many factors in addition to those listed above. Reactivation has been reported in patients after penetrating keratoplasty, argon laser trabeculoplasty, Nd YAG laser peripheral iridotomy, or treatment with excimer lasers, including cases in which ocular herpes had not occurred previously. It is important to realize that because most patients have latent HSV it is possible for a reactivation to occur despite a negative history of a primary infection. 

Pepose JS, Keadle TL, Morrision LA. Ocular herpes simplex changing epidemiology, emerging disease patterns, and the... 

Idoxuridine was the first widely used antivirus drug. It is superseded by aciclovir and is variably effective topically for ocular and cutaneous herpes simplex with few adverse reactions. 

Ocular antiviral chemotherapy in the horse is adapted from that used in herpes simplex virus (HSV) and varicella zoster keratitis in humans. The agents used are nucleotide analogs capable of inhibiting viral replication by competitive inhibition of the uptake of the nucleotide into the viral genome. These agents are virustatic and require an intact immune system to suppress or eliminate the virus from the eye. They probably do not eradicate any latent infection. The antiviral drugs available currently do not penetrate intact comeal epithelium and are poorly disseminated within the comeal stroma. The availability of these dmgs will vary in different countries and some may only be obtained from hospital pharmacies. 

Arcieri ES+, Arch Ophthalmol 123(2), 186 Ocular erythema Ocular herpes simplex... 

Liu X, Brandt C, Gabelt BA, Bryar P, Smith M, Kaufman P. Herpes simplex virus mediated gene transfer to primate ocular tissues. Exp Eye Res 1999 69 385-395. 

Idoxuridine (1 drop into infected eye/hr during the day and q. 2 hours at night) is indicated in the treatment of herpes simplex keratitis. By altering normal DNA synthesis, idoxuridine inhibits the reproduction of herpes simplex virus. IDU replaces thymidine in the enzymatic step of viral replication, produces faulty DNA, and hence a structure that loses its ability to infect and destroy ocular tissue. Corticosteroids can accelerate the spread of a viral infection and are usually contraindicated in herpes simplex epithelial infections. Idoxuridine occasionally causes irritation, pain, pruritus, inflammation or edema of the eyes or lids and allergic reactions, photophobia, corneal clouding, stippling, and punctate defects in the corneal epithelium. The punctate defects may be a manifestation of the infection, as healing usually takes place without interruption of therapy. 

Trifluridine, an antiviral agent (1 drop of 1% solution onto the cornea), is nsed every 2 honrs while awake until the corneal nicer has reepithelialized completely. Trifluridine is indicated for primary keratoconjnnctivitis and recurrent epithelial keratitis dne to herpes simplex virus types 1 and 2. In addition, it is nsed for epithelial keratitis that has not responded clinically to topical idoxnridine, or when ocular toxicity or hypersensitivity to idoxnridine has occurred. 

There are no reports on susceptibility of CXCR2 knockout mice to viruses. However, impaired neutrophil recruitment in response to viral infection has been reported in CCRl mice and MIP-lamice. In mice, CCRl is the dominant neutrophil MIP-1 a receptor, and thus mediates migration of neutrophils into peripheral blood in vivo in response to MIP- la (47). In human, the role of CCRl on neutrophils is less clear. It is expressed at low levels and appears to be chemotactically inactive on freshly isolated, resting human neutrophils however, expression and coupling can be upregulated in vitro by GM-CSF (48). In a blinding ocular inflammation model induced by herpes simplex virus type 1 (HSV-1), neutrophil counts in the corneas of MIP-1 a mice were reduced by more than 80% this was also associ-... 

Tigges MA, Leng S, Johnson DC, Burke RL (1996) Human herpes simplex virus (HSV)-specific CD8 + CTL clones recognize HSV- 2-infected fibroblasts after treatment with IFN-gamma or when virion host shutoff functions are disabled. J Immunol 156 3901-3910 Walker J, Laycock KA, Pepose JS, Leib DA (1998) Postexposure vaccination with a virion host shutoff defective mutant reduces UV-B radiation-induced ocular herpes simplex virus shedding in mice. Vaccine 16 6-8... 

Richards CM, Shimeld C. Williams NA et ah Induction of mucosal immunity against herpes simplex virus Type 1 in the mouse protects against ocular infection and establishment of latency. J Infect Dis 1998 177(6) 1451-1457. 

Richards CM, Aman AT, Hirst TR et ah Protective mucosal immunity to ocular herpes simplex virus Type 1 infection in mice by using Escherichia coli heat-labile enterotoxin B subunit as an adjuvant. J Virol 2001 75(4) 1664-1671. 

Herpes simplex viruses are human pathogens that cause oral and ocular lesions (HSV-1) or genital lesions (HSV-2). These viruses code for enzymes with substrate specificities different from those of the host cell. The pyrimidine metabolism of the cell is augmented by a virus-coded deoxythymidine (dThd) kinase (TK). This enzyme has a relatively broad phosphate acceptor specificity which permits the phosphorylation of several antiviral nucleoside analogs, the first step in their activation. These analogs are selective inhibitors of DNA synthesis in virus-infected cells, in part, because they are phosphorylated to their triphosphate derivatives only in infected cells. 

Absolute hypersensitivity to the drug or any other component of the product. Active or suspected ocular or periocular infection (herpes simplex keratitis, vaccinia, varicella, mycobacterial disease or fungal infection), systemic fungal infections, advanced glaucoma or concurrent administration of live vaccines in patients receiving immunosuppressive doses. 

---