Santos Carmen
Department of Ophthalmology University of Puerto Rico School of Medicine.
Bol Asoc Med P R. 2004 Mar-Apr;96(2):71-4, 77-83.
Uveitis in herpes simplex virus (HSV) ocular disease is usually associated with corneal stromal disease. It has generally been believed that herpetic uveitis in the absence of corneal disease is very rare. When seen it is usually attributed to varicella zoster virus (VZV) infections. The diagnosis of uveitis caused by herpes simplex is often not diagnosed resulting in inadequate treatment and a poor visual result.
Seven patients from a large uveitis practice who presented with a clinical picture of: anterior uveitis and sectoral iris atrophy without keratitis, a syndrome highly suggestive of herpetic infection, are reported. Polymerase chain reaction (PCR) was done in the aqueous of four of them and was positive for HSV. One patient had bilateral disease. Most of the patients also had severe secondary glaucoma.
Of the seven patients presented five had no history of any previous corneal disease. Two had a history of previous dendritic keratitis which was not active at the time of uveitis development. One patient with bilateral disease was immunosuppressed at the time when the uveitis developed. Six of the seven patients had elevated intraocular pressures at the time of uveitis and five required glaucoma surgery. Intractable glaucoma developed in two patients leading to rapid and severe visual loss despite aggressive management.
Findings suggest that uveitis without corneal involvement may be a more frequent manifestation of ocular herpes simplex disease than previously thought. Absence of corneal involvement delays a correct diagnosis and may worsen visual outcome. Primary herpetic uveitis (when there is no history of previous corneal disease) seems to be more severe than the uveitis in patients with previous corneal recurrences. The associated glaucoma may be a devastating complication.
单纯疱疹病毒（HSV）眼部疾病中的葡萄膜炎通常与角膜基质疾病相关。一般认为，无角膜疾病的疱疹性葡萄膜炎非常罕见。一旦出现，通常归因于水痘带状疱疹病毒（VZV）感染。单纯疱疹引起的葡萄膜炎常未被诊断出来，导致治疗不充分且视力预后不佳。
报告了来自一家大型葡萄膜炎诊所的7例患者，他们呈现出以下临床症状：无前角膜炎的前葡萄膜炎和扇形虹膜萎缩，这是一种高度提示疱疹感染的综合征。其中4例患者的房水中进行了聚合酶链反应（PCR），结果HSV呈阳性。1例患者为双侧疾病。大多数患者还患有严重的继发性青光眼。
在这7例患者中，5例既往无任何角膜疾病史。2例有既往树枝状角膜炎病史，但在葡萄膜炎发作时不处于活动期。1例双侧疾病患者在葡萄膜炎发作时处于免疫抑制状态。7例患者中有6例在葡萄膜炎发作时眼压升高，5例需要进行青光眼手术。2例患者发生难治性青光眼，尽管积极治疗仍导致快速且严重的视力丧失。
研究结果表明，无角膜受累的葡萄膜炎可能是眼部单纯疱疹疾病比以前认为的更常见的表现形式。无角膜受累会延迟正确诊断，并可能使视力预后恶化。原发性疱疹性葡萄膜炎（既往无角膜疾病史时）似乎比既往有角膜复发的患者的葡萄膜炎更严重。相关的青光眼可能是一种毁灭性的并发症。
