Purpose of review: To summarize the articles published in 2012 pertaining to the clinical presentation, diagnosis, and treatment of herpetic keratitis, with specific attention to pediatric population.
Recent findings: Liu et al. confirm prior literature that herpetic keratitis has higher recurrence rate in children than adults. Recurrences are more likely to occur as stromal disease. Vision loss in children is from corneal scarring leading to deprivation and/or refractive amblyopia. Acyclovir is safe and well tolerated as a treatment in pediatric population, and preferable to difficult and toxic eye-drop regimens.Immunochromatographic assay is an effective diagnostic tool to confirm diagnosis of herpes simplex virus-1 (HSV) in corneal scrapings with high specificity but poorer sensitivity.Real time PCR can be employed to follow changes in HSV viral load in patients where resistance is suspected.
Summary: Delays in treatment related to misdiagnosis, as well as resistance to current antiviral therapeutics, can lead to visually devastating corneal opacification. In the pediatric population, already at risk for amblyopia, this can be especially damaging. Children are unique with regards to the way in which they manifest herpetic keratitis, making rapid diagnosis and treatment even more challenging.