Birgitta Togni

Herpes simplex eye infections: Clinical manifestations, pathogenesis and management☆

Herpes infection of the eye may be acquired as the patients first exposure to the virus (primary infection) or as involvement of a new anatomical site (the eye) in a patient with previous HSV infection. In either case, patients with herpetic eye infection risk recurrent eye disease throughout their lives. The infective lesions of the corneal epithelium (dendritic and geographic ulcers) occasionally develop into noninfective indolent or trophic ulcers, particularly under the influence of cauterizing chemicals or corticosteroids. Inflammation of the corneal stroma may accompany herpetic epithelial lesions or occur independently. Stromal keratitis probably represents the hosts immune response to viral antigens filtering down from epithelial lesions or from viral replication in stromal cells. The clinical manifestations of ocular HSV infection are reviewed, pathogenesis and possible pathways of the infection are analyzed, and some practical guidelines for management and prevention are presented.

Herpesvirus Infection of Human Mesodermal Tissue (Cornea) detected by Electron Microscopy

Herpesvirus hominis (herpes simplex virus) usually infects tissues of ectodermal origin, particularly skin, mucous membranes and the central nervous system. Viral replication has been observed in mesodermal cells (principally leucocytes) in experimentally infected rabbits1 and mice2 and in tissue cultures of human leucocytes3 and embryonic fibroblasts4. There has been little evidence, however, that infection of mesodermal cells plays a part in primary or recurrent human infections.

Further investigations by electron microscopy of herpes simplex virus in the corneal stroma of rabbits with experimental keratitis

Herpes simplex virus particles were demonstrated by electron microscopy in the corneal stromal cells of a high percentage of rabbits with primary herpetic keratitis. Virus particles were found in the epithelial cells of all infected corneas. Experimental infection was achieved by dropping virus suspension on the cornea without any accompanying artificial trauma. The results demonstrate that the stroma can be infected by virus particles that have entered through the intact epithelium. The findings support the hypothesis that virus particles mature within nuclei and derive their outer coat, or membrane, from the inner leaflet of the nuclear membrane as they pass through it. Virus particles that apparently were phagocytosed by polymorphonuclear leucocytes consisted of a single coat or membrane; they lacked both a central core and an outer coat.