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.