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Anti-glaucoma agents-induced corneal toxicity may be misdiagnosed as herpetic simplex keratitis (HSK). In our study, nineteen glaucoma patients were presumed to have HSK before referral. Corneal lesions were classified into (I) linear pseudodendritic lesions formed by elevated opacified cells, (II) linear pseudodendritic lesions formed by grouped superficial punctate keratitis (SPK), (III) satellite full-thickness epithelial defects, (IV) satellite lesions formed by elevated opacified cells, and (V) geographic lesions formed by grouped SPK. We observed thirty-one events, with 15 in the lower and 16 in the central corneas. There were 21 (67.7%) type II, five (16.1%) type V, two (6.5%) of each for types III and IV, and one (3.2%) type I events. Among linear lesions (types I and II), 17 (77.3%) had horizontal and 5 (22.7%) had curvilinear orientations. Exposure duration to the last-added anti-glaucoma agent was three days to 14.5 years. About half of the events (16/31, 51.6%) used prostaglandin analogues, and 30/31 (96.8%) applied benzalkonium chloride (BAK)-containing agents. All lesions resolved within two months after decreasing offending medications or enhancing protection of ocular surface. In conclusion, anti-glaucoma agents-induced pseudodendritic keratitis presents majorly in central-lower cornea as horizontally linear lesions, and BAK-containing agents are observed in the most events., (© 2021. The Author(s).)

Herpes zoster (HZ, shingles) represents the secondary manifestation of an infection with varicellazoster virus (VZV). A reactivation of dormant VZV in the ophthalmic branch of the fifth cranial nerve leads to ophthalmic HZ (HZO). The predominantly older and immune compromised patients often present with eye involvement (approximately 50%) as well as characteristic skin changes. Clinical manifestations include the cornea and conjunctiva but anterior uveitis and (rarely) acute retinal necrosis may also occur. Associated sensory symptoms that range from paresthesia to severe pain may severely affect the quality of life. Particularly in immunocompromised and/or elderly patients, HZO is associated with complicated courses. Systemic antiviral treatment and an adequate pain medication are the mainstay of the recommended management. The present article provides an overview of the contents of the current consensus-based European guidelines on the management of HZ with a specific focus on HZO.

Objective:: Bacterial keratitis occurs worldwide, and despite recent developments, it remains a potentially blinding condition. This study assesses the presence of herpes simplex virus (HSV-1 and -2) and varicella zoster virus (VZV) by quantitative real-time polymerase chain reaction (qPCR) in corneal scrapings from patients with bacterial keratitis., Methods:: A total of 65 patients with clinical diagnoses of infectious corneal ulcers prospectively underwent clinical eye examinations. Corneal scrapings were investigated by Gram staining, Giemsa staining, culture, and qPCR (the study group). Risk factors and epidemiological data were recorded. The control group comprising 25 eyes with typical herpes dendritic keratitis was also analyzed by qPCR., Results:: From the study group (n=65), nine patients (13.8%) had negative smears, cultures, and qPCR findings. Fifty-six (86.2%) patients had positive cultures: 51 for bacteria, 4 for fungi, and 1 for amoebae. Of the patients who had positive bacterial cultures, qPCR identified 10 patients who were also positive for virus: one for VZV and nine for HSV-1. Of the 25 patients in the control group, 21 tested positive for HSV-1 by qPCR analysis., Conclusions:: Herpes may be present in patients with bacterial corneal ulcers, and qPCR may be useful in its detection.

Purpose: To analyze the clinical presentation, characteristics, treatment, recurrences, and final outcomes and complications of herpes simplex virus (HSV) disease of the anterior segment in patients aged 17 years or younger., Methods: This is an observational and retrospective study with review of the medical records of all the children diagnosed with herpes simplex infection of the anterior segment at an ophthalmologic referral center, from 2002 to 2012. The diagnosis was made on the basis of the history and examination of patients and in specific cases by viral culture and the polymerase chain reaction. Main outcome measurements included final visual acuity, bilateral disease, and recurrence. Recurrent disease was analyzed with Kaplan-Meier curves., Results: A total of 103 patients were included with a median age at presentation of 9 years. Of them, 6 had bilateral and simultaneous disease. The median follow-up time was 18 months (range, 18 days-12 years). The most common clinical manifestations were epithelial dendritic keratitis in 42 eyes (38.5%) and interstitial keratitis in 39 eyes (35.7%), with 15 patients presenting multiple forms of HSV disease. The median final visual acuity in the group of patients was 20/40. Recurrent disease was evident in 42 (38.5%) of the eyes, with a median recurrence time of 15 months (95% confidence interval, 8.1-26.2 months)., Conclusions: In this study, epithelial dendritic and interstitial keratitis were the most frequent forms of disease in the pediatric population with HSV of the anterior segment. A high rate of recurrent disease was present.

Purpose: To report the clinical and in vivo confocal microscopic (IVCM) findings of corneal deposits in a patient with tyrosinemia type II., Methods: The pretreatment and 1-month posttreatment slit-lamp examination and IVCM findings of a patient with tyrosinemia type II are described., Results: A 12-year-old girl diagnosed with tyrosinemia type II was evaluated for photophobia and bilateral ocular discomfort of 1-year duration. The patient had been placed on topical acyclovir treatment with the diagnosis of recurrent bilateral herpetic keratitis during the previous 12 months. Slit-lamp examination revealed bilateral dendritiform epithelial lesions in the central cornea, which stained poorly with fluorescein. IVCM highlighted multiple hyperreflective linear crystalline deposits at the level of superficial epithelium. One month after discontinuation of acyclovir treatment and initiation of a protein-restricted diet therapy, improvement in the patient's symptoms and regression of corneal epithelial lesions was noted. Reduction in the extent of corneal deposits was also confirmed with IVCM., Conclusions: Corneal involvement, secondary to hereditary tyrosinemia type II, is characterized by pseudodendritic epithelial lesions on slit-lamp examination and hyperreflective linear deposits in the superficial epithelium using IVCM. These lesions may regress expeditiously with a low-protein diet. IVCM may be a useful tool in the differential diagnosis of this disorder by highlighting the crystalline structures in the superficial epithelial layers and also in evaluating the response to the treatment in patients with tyrosinemia type II.

Herpes simplex virus (HSV) is a common cause of keratitis. "Herpetic keratitis" is a chameleon, which is well treatable today if the various types of clinical expression of this disease are known to the ophthalmologist and treatment is adjusted accordingly. Types of expression include 1. epithelial keratitis (dendritica/geographica), 2. stromal keratitis (necrotizing vs. non-necrotizing = "interstitial keratitis"), 3. endotheliitis (=disciform keratitis), 4. neurotrophic keratopathy (=so-called metaherpetic keratitis) and 5. (vascularized) corneal scars. A concomitant ocular hypertension should be treated predominantly non-surgically (no prostaglandin analogues). Topical artificial tears (if necessary with acyclovir ointment at night) in the quiet interval are recommended to limit the tendency towards recurrences. After keratoplasty and in cases of severe recurrences of herpetic keratitis, systemic acyclovir application (2×400 mg/day) for at least 1 year is indispensable! Overall, HSV has lost its "terror" today, even after keratoplasty, given adequate management.

Purpose: To describe the characteristics and course of late varicella-zoster virus (VZV) dendriform keratitis in patients with histories of herpes zoster ophthalmicus (HZO); to describe responses of corneal lesions to antiviral treatment; and to investigate risk factors for recurrence., Design: Retrospective case series., Methods: Included were patients known to have 1 or more episodes of dendriform lesions beginning at least 2 weeks after HZO in 2 academic practices. Epithelial lesions were evaluated for the presence of VZV DNA by a polymerase chain reaction assay. Demographic, medical, and ophthalmic data were collected for each episode. Responses to treatment with antiviral medications were evaluated. Cumulative risk of recurrence was determined using Kaplan-Meier analysis; potential risk factors for recurrence (age, systemic disease, lesion characteristics, corticosteroids) were evaluated using univariate Cox proportional hazard models., Results: We identified 20 patients (14 women; median age, 65 years) who met inclusion criteria. Dendriform lesions were pleomorphic with thickened, opaque epithelium. Seven patients had systemic diseases characterized by altered immune function. VZV DNA was identified in 15 of 16 cases tested, and all lesions responded to antiviral therapy. The 1-year incidence of first recurrence was 95.8 lesions per 100 person-years of follow-up. Patients had multiple recurrences, but risk of recurrence appeared to decrease over time. No statistically significant risk factors for recurrence were identified., Conclusions: Late dendriform lesions associated with HZO are foci of productive VZV infection. Lesions can be treated effectively with topical or systemic antiviral agents. Patients can have multiple recurrences of dendriform lesions despite treatment., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

A man, 75 years of age, presents with a red, painful, watery right eye of 1 week duration. He describes photophobia but says his vision is not reduced or blurry. He was seen at another clinic after 2 days of symptoms and was prescribed topical chloramphenicol antibiotic eye drops. Despite using the eye drops for 5 days, there has been no improvement in his symptoms. The man has no significant ocular past history.

Background: Bilateral herpetic keratitis has been reported in patients with atopy, measles, graft-versus-host disease, and altered immune status. We report a serologically verified case of primary, simultaneous onset, bilateral, atypical epithelial herpetic keratitis that manifested as dendriform epithelial edema during a generalized dermatitis incident., Case: A 37-year-old man with chronic atopic dermatitis developed Kaposi's varicelliform eruption and bilateral dendritic epithelial keratitis with corneal epithelial edema., Observations: The pathogens isolated from both eyes were identified as herpes simplex virus type 1 (HSV-1) by a direct immunofluorescence method. Serological tests obtained on three different occasions over a 5-week period verified a primary HSV infection., Conclusions: With serological verification, we report a rare case of primary, simultaneous onset, bilateral, dendritic epithelial keratitis at a very early stage with complications of generalized herpetic disease in a patient with atopic dermatitis.

Herpes simplex virus ocular infections are a major cause of corneal blindness in the developed world. Signs of a primary infection are limited to the lids, conjunctiva and cornea. The presence of a conjunctival dendrite without corneal involvement has been reported. Although conjunctival ulceration has been associated with recurrent attacks, it has not been documented as a manifestation of primary herpetic infection. We report a case of primary herpetic infection with geographic conjunctival ulcer with multiple corneal dendrites.

Herpes simplex virus ocular infections have been recognized as a major cause of corneal blindness in the developed world. The major signs of a primary infection are limited to the lids, conjunctiva, and cornea. Presence of a conjunctival dendrite without corneal involvement has been reported. Although conjunctival ulceration has been associated with recurrent attacks, it has not been documented as a manifestation of primary herpetic infection. We report a case of primary herpetic infection with geographic conjunctival ulcer with multiple corneal dendrites.

Bilateral pseudo-dendritic keratitis in infancy can be due to tyrosinemia, a rare metabolic disorder. Ocular involvement may be the earliest presenting manifestation of this disease. Early diagnosis is essential because dietary modifications can result in complete reversal of the manifestations of this disorder. This disease must be suspected in all cases of non-responsive dendritic keratitis in the pediatric age group, especially if it is associated with cutaneous lesions such as patmoplantar keratosis. Serum tyrosine levels must be done in these cases.

Purpose: To introduce into the clinical nomenclature a sign frequently observed in our patients with persistent corneal inflammation associated with herpetic stromal keratitis., Methods: Case reports and review of the literature., Results: Four representative patients with herpesvirus stromal keratitis are presented. Herpes simplex virus-1 (HSV-1) was confirmed by culture in 1 case and by polymerase chain reaction in a second case. In the remaining 2 cases, the diagnosis was made based on characteristic clinical findings for herpes simplex virus and varicella zoster virus (VZV). On clinical examination, all 4 representative cases of stromal keratitis revealed a well-defined, localized region of intertwined, metallic-like, polychromatic material in the corneal stroma, a sign we have termed steel wool keratopathy. We have only rarely observed this finding in patients with stromal keratitis not caused by a herpesvirus., Conclusion: Steel wool keratopathy seems to represent a focal region of stromal degeneration or deposition associated with chronic inflammation. Although we most often observe this finding in patients with stromal keratitis secondary to HSV or VZV, we cannot exclude the possibility that this sign represents the sequelae of chronic/recurrent inflammation rather than a specific pathologic response to herpetic antigens.

Purpose: To report a case of chronic recurrent varicella virus epithelial keratitis in a child., Design: Case report., Methods: Clinical examination and polymerase chain reaction analysis of corneal epithelium., Results: A 10-year-old healthy child developed chronic recurrent varicella virus keratitis with pseudodendrites after recovering from systemic varicella. Analysis of the debrided pseudodendrites was repeatedly positive for VZV DNA and negative for HSV DNA. Treatment with oral acyclovir and topical corticosteroid drops was effective in eliminating the pseudodendrites; however, recurrences occurred once the medications were discontinued., Conclusions: Varicella virus epithelial keratitis in children can be a recurrent chronic condition requiring prolonged treatment.

Purpose: To report a series of patients with no previous history of herpes simplex virus (HSV) infection who had new onset of herpetic keratitis after penetrating keratoplasty (PK)., Design: Noncontrolled, retrospective case series., Methods: We included in the study the patients who had new onset of herpetic keratitis after penetrating keratoplasty for corneal diseases unrelated to HSV infection who were seen at the Cornea Service at Wills Eye Hospital (Philadelphia, Pennsylvania) from January 1996 to December 2002. The diagnosis of HSV epithelial keratitis was based on clinical characteristics of either a classic herpetic dendrite, a geographic ulcer, or a nonhealing epithelial defect that responded only to antiviral therapy., Results: Fourteen patients were included in the study. Eight of these (57%) had presented with a geographic ulcer whereas six patients (43%) had a classic dendrite. The most common primary corneal disease that led to PK was pseudophakic bullous keratopathy (36%), followed by keratoconus (29%), Fuchs dystrophy (21%), and corneal scar unrelated to HSV (14%)., Conclusions: The ophthalmologist should be aware of the possibility of herpetic keratitis in eyes after PK, even in patients with no previous history of HSV infection.

Background: Viral infections of Herpes origin are the most commonly encountered ones in man. The most important member of this family is the Herpes simplex virus (HSV), two varieties of which are known to exist: HSV-1 affects predominantly the upper half of the body, whereas HSV-2 is associated mainly with diseases of the urogenital tract. In the immunocompetent host, viral replication is usually confined to cutaneous and mucocutaneous sites, invasion of subcutaneous tissues being impeded by an early onset of non-specific defence mechanisms. These are rapidly complemented by the specific, mainly cellular, immune response., Patients: Epithelial dendritic keratitis is the first symptomatic clinical finding, and after several recurrences, the corneal stroma may become involved. This condition of herpetic stromal keratitis (HSK), which, in contrast to the epithelial one, is believed to be directed by a predominantly immunopathological process, is one of the leading causes of infectious blindness in developed countries., Results: The mechanisms underlying HSK, and the establishment of viral latency and reactivation are poorly understood. But on the basis of studies with mice as well as clinical immunohistological observations, evidence is now accumulating in support of a cell-mediated mechanism being responsible for corneal destruction., Conclusion: Our present knowledge of the pathogenesis of herpetic keratitis is incomplete. The different pathophysiological aspects reflecting our current understanding, such as that of a virally induced autoimmune disease, form the basis of accepted clinical treatment concepts.

Purpose: To demonstrate the presence of an active herpetic dendrite in an eye-bank cornea., Case Report: One eye-bank cornea was studied. Viral cultures and polymerase chain reaction (PCR) testing were performed 4 days after tissue preservation. The presence or absence of herpes simplex virus (HSV) type 1 was investigated., Results: The presence of an active HSV dendrite in an eye-bank cornea was verified. HSV type 1 was confirmed using PCR amplification and restriction endonuclease DNA fragment analysis., Conclusion: This case suggests that HSV may remain viable in stored corneal tissue at 4 degrees C.

A study was performed to evaluate nested PCR (nPCR) versus viral cultures as method and tear film versus corneal scrapings as specimen in the diagnosis of viral keratoconjunctivitis. Tear film specimens were taken from both eyes and corneal scrapings from the affected eye only in 17 patients with suspected viral keratoconjunctivitis. In 15 of the 17 patients the viral agent of the infection could be detected: 11 patients had herpes simplex virus type 1, two varicella-zoster virus, one both herpes simplex virus type 1 and varicella-zoster virus, and one adenovirus. Overall there was no significant difference between the detection rate for corneal scrapings (85%) and tear film (75%). In both types of specimens nPCR showed a higher detection rate than viral cultures (corneal scrapings: 87.5% vs 31.25%; tear film: 75% vs 12.5%; P 0.05). For the diagnosis of keratoconjunctivitis nPCR is superior to viral culture and tear film is an adequate sample that is easier to collect, causing the patient less discomfort.

Three patients, women aged 69, 25 and 30 years, with refractory keratitis were found to have a rare infection with Acanthamoeba. All wore soft contact lenses. The frequency of Acanthamoeba keratitis increased in recent years. At present, an efficacious antiprotozoal therapy is available, for instance in the form of polyhexamethylene biguanide and propamidine. In cases of refractory keratitis, the possibility of an Acanthamoeba infection should be taken into account.

Background: The late-onset pseudodendrites, delayed corneal mucous plaques, of herpes zoster ophthalmicus are reported to be of mechanical or immune origin and to be worsened by antiviral therapy., Objective: To study pseudodendrites to ascertain a viral presence in the lesions and their response to antiviral therapy., Design: Prospective clinical study., Setting: Outpatient and inpatient hospital-based corneal specialty referral practice; molecular virology laboratory., Patients: Six patients, aged 33 to 89 years, four with delayed herpes zoster ophthalmicus pseudodendrites and two with herpes zoster ophthalmicus neurotrophic ulceration. One patient was immunosuppressed., Main Outcome Measures: Findings from clinical evaluation; polymerase chain reaction assays of lesions and tear film of six patients; polymerase chain reaction and light and electron microscopy of the corneal button from one patient; and the clinical response of four patients to various antiviral drugs., Results: In contrast to reports in the current literature, delayed pseudodendrites may also be infectious, as they are positive for zoster DNA by polymerase chain reaction and appear responsive to certain antiviral therapy. The corneal button from an immunosuppressed patient had mature and immature viral particles in the basal cells within 2 weeks of transplantation., Conclusions: To our knowledge, this is the first report of viral DNA in delayed zoster pseudodendrites. Recurrent viral infection may play a role in this form of zoster keratopathy and warrant antiviral therapy.

Medical records of 17 cats with ocular disease attributable to herpesvirus injection were reviewed. Herpesvirus infection was confirmed by a positive result on an immunofluorescent antibody test or by detection of dendritic corneal ulcers. Cats were 3 months to 23 years old (mean, 4.8 years). Sex or breed predilections were not evident. Vaccination history was available for 13 cats, 9 of which had been adequately vaccinated against feline viral rhinotracheitis, calici, and panleukopenia viruses. Six cats had a history of respiratory tract disease. Twelve cats were tested for FeLV, and 3 had positive results; 7 cats were tested for feline immunodeficiency virus, with 1 positive result. The most common ocular abnormality seen was conjunctivitis (13/17 cats), followed by dendritic corneal ulcers (10/17 cats). Keratitis was detected in 6 of 17 cats, and nondendritic corneal ulcers in 3 of 17 cats. Corneal sequestra were evident on initial examination or developed during the follow-up period in 4 of 17 cats. Keratoconjunctivitis sicca was diagnosed in 2 of 17 cats, and anterior uveitis was evident in 1 of 17 cats. All cats had 2 or more clinical ocular abnormalities associated with herpesvirus infection. Treatment with topically applied antiviral medications was instituted in 14 cats, including idoxuridine in 7, vidarabine in 4, and trifluridine in 3. Antibiotics were used topically in 10 cats, and atropine was used in 3 cats. Topical administration of corticosteroids was used in 2 cats. Recombinant human alpha-interferon was given orally to 3 cats in conjunction with topical administration of antiviral agents. In addition to medical treatment, 4 cats were treated surgically.(ABSTRACT TRUNCATED AT 250 WORDS)

Herpes simplex virus (HSV) antigens in corneal or conjunctival epithelial lesions were detected by impression cytology. Specimens were obtained using a nitrocellulose membrane and were stained by the peroxidase-antiperoxidase method. HSV antigens were demonstrated in 30 of 32 patients with herpes simplex keratitis or conjunctivitis. Impression specimens of dendritic or stellate keratitis lesions exhibited precise replicas of corneal lesions with numerous antigen-positive cells. HSV antigens were also detectable in some of the minute stellate and/or punctate epithelial keratitis lesions even during the course of antiviral treatment. Impression cytology is noninvasive and useful for a rapid etiological diagnosis of herpetic epithelial lesions.

A 50 year old patient with non-diagnosed HIV-infection at onset of his illness developed impairment of vision and temporary double vision combined with severe hemianopsia. With normal fundus and suspicious Herpes simplex iritis therapy with Acyclovir was started. Primarily the patient showed a good response to the therapy and loss of vision could be prevented. After 4 weeks CMV-retinitis developed. In spite of Gancyclovir therapy manifestation of total loss of vision after 6 weeks. Autopsy demonstrated signs of simultaneous a CMV-infection of the retina and a herpes simplex-infection of the optic nerve combined with a Non-Hodgkin-Lymphoma of the optic tract.

The Laser Flare Cell Meter (LFCM, Kowa FC-1000), an instrument measuring aqueous flare and cells in a quantitative, objective and non-invasive way, has been mainly used so far to measure inflammation in clinical and experimental research. In the light of some illustrative examples, its practical clinical usefulness is presented; the LFCM was found to be specially helpful in 3 types of situations. 1. In acute anterior uveitis (AAU) patients, precise LFCM monitoring of inflammation made it possible to avoid excessive corticosteroid therapy, mainly by more rapid and controlled tapering at the end of an inflammatory episode, so possibly minimizing steroid side effects in a group of patients prone to numerous uveitis recurrences. In a steroid-responder patient it allowed successful treatment of a flare-up of AAU with a combination of systemic and topical diclofenac (Voltaren), a potent nonsteroidal antiinflammatory drug. 2. LFCM monitoring of inflammation in patients undergoing laser treatments allowed optimal adjustment of antiinflammatory therapy. Diclofenac drops (Voltarene Ophta), were sufficient to treat inflammation in all patients, undergoing Nd-YAG laser posterior capsulotomy or Argon laser trabeculoplasty. 3. In patients with acyclovir treated herpes simplex or herpes zoster uveitis corticosteroid treatment should be avoided whenever possible, because of the tendency to develop steroid dependency. LFCM monitoring of this group of patients gave a precise evolutionary pattern of inflammation and permitted to avoid steroid treatment in many patients.

Penetrating keratoplasty (PKP) in conjunction with postoperative corticosteroids may reactivate latent herpes simplex virus type 1 (HSV-1) to cause persistent postoperative epithelial defects. The clinical diagnosis of HSV keratitis after penetrating keratoplasty is difficult because the postoperative appearance may be nondendritic and, therefore, not characteristic of HSV-1 infection. Presently, the most reliable method to diagnose HSV-1 under these conditions is to culture eyes for the presence of HSV-1. To determine the coincidence of positive HSV-1 ocular cultures with HSV-1 epithelial defects, 15 rabbits (20 eyes) latently infected with HSV-1 underwent autograft PKP with postoperative corticosteroids. Daily ocular cultures and slit-lamp examinations were performed on postoperative days 1-8 and 10. Viral shedding occurred in 15 of 19 (79.0%) of the eyes postoperatively. Superficial punctate keratopathy (SPK) was observed in 19 of 19 (100%) of the eyes and coincided with positive HSV-1 cultures 24% of the time. Dendritic lesions were observed in three of 19 (15.8%) of the eyes; the dendrites coincided with positive HSV-1 cultures 60% of the time. Finally, epithelial ulcers were seen in eleven of 19 (57.9%) of the eyes, thus coinciding with HSV-1 positive cultures 29% of the time. The greatest coincidence of positive HSV-1 cultures with nondendritic epithelial lesions occurred on postoperative day number 4. The results suggest that an epithelial lesion following PKP and postoperative corticosteroids could represent HSV infection, even if a single HSV ocular culture is negative.

Rapid diagnosis of viral diseases of the outer eye was attempted by means of immunohistochemical methods. Specimens were obtained with a nitrocellulose membrane, used as a blotter of immunoblotting test. An impression of the corneal or conjunctival surface was obtained by anesthetizing the eye and lightly pressing the membrane against the tissues. In some cases, scraping materials were taken on a slide glass. Viral antigens in the specimens were detected by peroxidase-antiperoxidase (PAP) method, ABC system (Vectastain), or immunofluorescence. Four common diseases were studied. Dendritic corneal lesions caused by herpes simplex virus (HSV) were impressed on the membrane, and exhibited exact duplicates of lesions which were composed of PAP-positive epithelial cells. Under a high magnification, pathologic changes such as margination of chromatin, intranuclear inclusion bodies, and multinucleated giant cells were observed. Of 27 cases of epithelial herpetic keratitis, 25 showed positive results. The impression can permit examination of a minute lesion, therefore, is superior to scraping. Dendritic lesions caused by varicella-zoster virus (VZV) have a characteristic morphology different from those of HSV. Impressions showed the virus antigen, when treated with fluorescein-labeled anti-VZV monoclonal antibody. Appearance of such a dendrite in disorders of unknown cause indicates the etiology. Conjunctival impressions of adenovirus (Adv) conjunctivitis examined by the PAP method revealed Adv-antigen containing cells. Of 64 cases analyzed, 24 PAP-positive cases were compared with the 35 culture-proven cases. The sensitivity of PAP method was 69%, and the specificity was 97%. The detection rate varied according to serotype, and was especially low (33%) in type 3. Guinea pig antisera with high titers against enterovirus type 70 (EV70) and a variant of coxsackievirus A type 24 (CA24v), the causative viruses of acute hemorrhagic conjunctivitis (AHC), were obtained. Using these sera as the primary antibody, the antigen of each virus was localized in the cytoplasm of infected HeLa cells by either ABC, or immunofluorescence. Conjunctival cells from patients with EV70 AHC were antigen-positive for 3 days after the onset of disease. Though epidemics of CA24v AHC have only been experienced in Okinawa, sporadic cases have been observed in other districts of Japan.

Acute retinal necrosis (ARN) is characterized by unilateral or bilateral severe vaso-occlusive retinitis. In a large number of cases the patients become blind in the affected eyes as a direct result of the acute inflammation or the subsequent retinal detachment. The etiology is poorly understood; herpesvirus-induced vasculitis is presumed and has been demonstrated by some authors. However, the author's own investigations in seven patients show that even vitreous biopsy reveals a herpetic origin only in a minority of cases. Intravenous treatment with acyclovir and steroids prevented progression of the retinitis but did not reduce the risk of retinal detachment.

Monoclonal antibodies against HSV (HSV-McAb) were used in the diagnosis of 127 cases of keratitis by immunofluorescence assay (IFA). The positive rate in 43 cases of epithelial and 50 cases of stromal HSK were 100% and 92% respectively. The IFA was negative in 20 cases of keratitis of non-HSV etiology and 38 cases of normal cornea (31 cases of epithelial smears and 7 cases of cornea paraffin sections). Among 14 cases of clinically doubtful HSK, 4 cases were positive. The IFA was completed within 2-3 hours after sampling. The procedure proved rapid, sensitive, and highly specific for etiological diagnosis of HSK.

We determined the in vitro sensitivities and the diagnostic efficacies of a commercially available latex agglutination test and an enzyme-linked immunosorbent assay using a rabbit model of herpes simplex virus type 1 dendritic keratitis. In contrast to the latex agglutination test, the HERPCHEK enzyme-linked immunosorbent assay offers an extremely sensitive and reliable means of laboratory diagnosis of experimental herpes simplex virus keratitis and is more rapid than viral isolation in tissue culture.

In 58 patients with chronic conjunctivitis of greater than two weeks' duration, examination included obtaining an ocular and general medical history and performing a complete ophthalmic examination of the external eye. Conjunctival smears were obtained for Gram and Giemsa staining, direct immunofluorescent monoclonal antibody staining for Chlamydia trachomatis and herpes simplex virus, and chlamydial culture. Cultures for bacteria and viruses were obtained in 33 patients. The cause of the chronic conjunctivitis based on clinical and laboratory criteria was established in 40 of 58 (69%) patients: chlamydia, 11 (19%); virus, eight (14%); irritant, six (10%); allergen, four (7%); contact lens, four (7%); bacteria, four (7%); acne rosacea, two (3%); and floppy eyelid syndrome, one (2%). In 18 of 58 (31%) patients, no specific cause was detected. We recommend a systematic approach in the investigation of chronic conjunctivitis. Direct immunofluorescent monoclonal antibody staining is an effective and rapid technique for detecting chronic chlamydial conjunctivitis.

We compared two commercially available tests, a direct immunofluorescence assay and an enzyme-linked immunosorbent assay (ELISA), to viral isolation in tissue culture for the laboratory diagnosis of untreated and partially treated experimental herpes simplex virus keratitis. New Zealand albino rabbits were inoculated bilaterally with herpes simplex virus-1 McKrae strain after corneal scarification. One eye of each rabbit was treated with a 1% trifluorothymidine solution daily, starting on the third day after inoculation. The direct immunofluorescence assay showed lower sensitivity for herpes simplex virus detection than viral isolation in tissue culture for both untreated and partially treated eyes. The Herpchek ELISA demonstrated similar sensitivity to tissue culture in detecting herpes simplex virus in untreated eyes. In the treated group, however, the Herpchek ELISA showed a higher percentage of eyes positive for herpes simplex virus than did viral isolation in tissue culture. After the initiation of antiviral therapy, eyes that no longer harbor infectious virus that can be isolated in tissue culture may remain herpes simplex virus antigen-positive and thus be more amenable to laboratory diagnosis using the rapid ELISA method.

A 35-year-old man had developed recurrent herpetic keratitis characterized by dendritic keratitis at intervals of a year. We were able to culture cytopathic agents repeatedly from his lesions by inoculating Vero cells. The cultures yielded definitive evidence of a virus that caused a cytopathic effect within 3 days. However, these virus strains could not be identified as herpes simplex virus (HSV) in immunofluorescence assays using the Syva MicroTrak HSV1/HSV2 direct specimen identification/typing test. Rather they were identified as strains of HSV type 1 (HSV-1) on the basis of plaque morphology, neutralization tests, electron-microscopic examination and DNA restriction endonuclease analysis. Our results allow us to assume the existence of HSV-1 strains isolated clinically that are negative to analysis using the Syva Micro-Trak HSV1/HSV2 direct specimen identification/typing test.

The paper analyses results after treatment of 30 patients with herpetic keratitis by means of a specific antiherpetic immunoglobulin manufactured at the Sverdlovsk Research Institute of Virus Infections. As compared with traditional treatment, the terms of clinical recovery and the number of bed-days reduced. The preparation can be used in a complex treatment of patients with a herpetic disease.

The authors report four cases in which retinal biopsy findings yielded unexpected or previously unreported diagnoses in patients with inflammatory retinitis. The tissue diagnoses included Wegener's retinal vasculitis in an immunosuppressed patient with a clinical diagnosis of cytomegalovirus retinitis, a novel viral form in the retina of a patient with cytomegalovirus retinitis, a case of acute retinal necrosis due to cytomegalovirus infection in an immunologically normal adult, and a case of ganciclovir-resistant herpes family viral retinitis. These cases illustrate the use of retinal biopsy in obtaining tissue for diagnosis and guiding treatment in selected cases of retinitis.

Electrophysiologic studies were conducted in 34 patients with herpetic lesions of the cornea (35 eyes with the active process and 33 clinically healthy fellow eyes). The control group included 30 healthy persons (60 eyes). In the control group, the threshold of electric sensitivity of the eye was 25.1 mcA, on the average. In the examined groups, it increases to 31.9 mcA (p less than 0.0017) in the group of patients with herpetic keratitis and to 28.7 mcA (p less than 0.05) in the group of patients with clinically healthy fellow eyes. The average value of optic nerve lability was 54.5 Hz in the control group. Reduced lability was recorded in group I--48.6 Hz (p less than 0.001) and in group II--52.6 Hz (p less than 0.02). No statistically significant differences in electrographic values were found. The electrophysiologic studies of eyes with localization of herpetic process in the cornea have shown the involvement of internal layers of the retina and the optic nerve into the pathological process. Similar changes appear in the clinically healthy fellow eyes as well, but to a lesser degree. The determination of the threshold of electric sensitivity and lability of the optic nerve can be used for diagnosing changes in internal layers of the retina and the optic nerve in herpetic keratitis.