Herpes simplex keratitis and keratoconus in the atopic patient. A clinical and immunological study.

Selected case histories indicate that there is good evidence that atopic disease is associated with severe primary and recurrent ocular herpes. The salient features of the syndrome are that the disease is often bilateral, that recurrences are more frequent, and that the corneal epithelium is often slow to regenerate after disease. Therapeutic difficulties may be encountered because atopic eye disease requires anti-inflammatory therapy which is contraindicated in epithelial herpes. Keratoplasty in herpetic disease in the presence of vascularization or atopic eye disease should be avoided, as an augmented homograft reaction is also an occasional complication. Screening of patients for serum immunoglobulins and cellular immunity using in vitro lymphocyte transformation and macrophage migration inhibition tests, failed to reveal any group evidence of immune deficit, but there was evidence of this in some individuals. The most serious management problems occurred in the presence of raised IgE levels. In a group of patients with keratoconus, IgE was raised in 17 per cent, and there was a depression of IgA in 8 per cent. A knowledge of the serum innumoglobulin levels can be of help in the management of the keratoconus patient in the postoperative period after keratoplasty.