Refractive Surgery for Ocular Herpes Patients: Proceed with Caution

Undergoing refractive surgery can carry serious risks if you have ocular herpes. Any corneal trauma or ultraviolet light exposure caused by the laser can result in a flare-up of your herpes condition, leading to an assortment of other eye issues. If a dormant case of ocular herpes gets reactivated during your refractive procedure, it can lead to the following complications:

While these risks are very serious, there are still ophthalmologists who will move forward with refractive surgery on herpes patients. That being said, not all ocular herpes patients will be deemed candidates for refractive surgery. Your ophthalmologist will have to make that determination based on a variety of factors associated with your condition.

In many cases, your ability to undergo refractive surgery will depend on how long it has been since you have had a flare-up of herpes. “If I had a patient with a herpes episode 10 years ago and it went away and never came back and the cornea looked perfect – zero haze, zero scar – I think it’s reasonable, with proper informed consent, to do refractive surgery,” said Dr. Christopher Rapuano, the co-director of Cornea Service and Refractive Surgery Department at Wills Eye Institute in Philadelphia.

Unfortunately, it is not always easy to diagnose whether a potential refractive surgery patient has ocular herpes or determine when their last episode occurred. Often, patients can be unaware that they even have ocular herpes. Symptoms can be as minor as a red eye, leading patients to believe they just experienced a mild case of conjunctivitis. Additionally, testing for ocular herpes is not effective since such a large percentage of people have been exposed to the virus in some form, creating a considerable number of false positives.

As a precaution, ophthalmologists should always check patients’ corneal sensitivity and look for signs of scarring, thinning, or neovascularization when determining candidacy for refractive surgery. This can prevent many unnecessary complications down the road.

Study Demonstrates Antiviral Treatment may Prevent Recurring Eye Complications Related to Herpes Simplex

Golden, Colorado – A longitudinal study conducted from 1976 through 2007 has demonstrated that taking oral antiviral prophylaxis after infection with herpes simplex virus (HSV) has been linked to a decrease in the likelihood of recurring eye problems associated with the disease. This study was recently published in the September issue of the Archives of Ophthalmology.

Herpes simplex virus has been known to cause corneal disease, and it is one of the leading infectious causes of corneal blindness across the world. Recurrence rates of ocular herpes after an initial outbreak have been quite high:

  • 10% after one year
  • 23% after two years
  • 36% after five years
  • More than 60% after 20 years

This high recurrence rate is especially problematic since repeated outbreaks of ocular herpes can result in stromal inflammation or neurotrophic keratitis.

The study evaluated 394 patients with ocular herpes during the 30 year time period. A little less than half (175 patients) were treated with oral antiviral therapy for an average of 2.8 years. Researchers found that patients who did not receive oral antiviral medication were:

  • 9.4 times more likely to have a repeated outbreak of epithelial keratitis
  • 8.4 times more likely to have a repeated outbreak of subepithelial, deep, or necrotizing stromal keratitis
  • 34.5 times more likely to have a repeated outbreak of blepharitis or conjunctivitis

Out of the 394 patients, 20 developed adverse issues such as loss of vision and corneal perforation. Almost all of these patients (17 out of 20) had not taken oral antiviral prophylaxis.

Based on the data, researchers have recommended that oral antiviral prophylaxis be considered for patients experiencing regular recurrences of corneal disease. However, they have also acknowledged that additional research into potential reasons for failed antiviral prophylaxis compliance and an evaluation of the cost-effectiveness of this therapy is also needed at this time.