Czech and Slovak Ophthalmology 376 10.31348/2025/30 Review Herpes Simplex Virus Infection of the Anterior Segment of the Eye and its Clinical Presentation. A Review Biensky Michal https://orcid.org/0009-0003-4811-6571 Bačová Petra https://orcid.org/0009-0007-5989-2719 Kováč Vladimír https://orcid.org/0009-0000-7047-1463 Leštachová Michaela https://orcid.org/0009-0000-8314-3645 Jančo Ladislav https://orcid.org/0000-0002-8114-0974 10 7 2025 6 1

Herpetic infections frequently cause diagnostic errors, which subsequently lead to mistakes in therapy. They affect all the ocular structures, although in everyday practice we most frequently encounter herpetic infections of the anterior segment of the eye. This review article focuses on infections of the anterior segment of the eye caused by the herpes simplex virus. It explains in further detail the specific pathophysiology and course of herpetic infection, which is closely related to the clinical manifestations of the disease. The various stages of primary and secondary infection are described in detail and documented with photographs from the 2nd Eye Clinic of the Slovak Medical University at F.D. Roosevelt Hospital in Banská Bystrica. The last two sections focus on the diagnosis and treatment of herpes simplex virus infections. Correct identification of the form of herpetic disease is crucial for proper therapeutic management.

 herpetic keratitis HSV 1 HSV 2 dendritic keratitis disciform keratitis endotheliitis antivirotic drugs References Coffin J, Blomberg J, Fan H, et al. ICTV Virus Taxonomy Profile: Retroviridae 2021. J Gen Virol. 2021 Dec 23;102(12):001712. Liu YT, Jih J, Dai X, Bi GQ, Zhou ZH. Cryo-EM structures of herpes simplex virus type 1 portal vertex and packaged genome. Nature. 2019 Jun;570(7760):257-261. doi: 10.1038/s41586-019-1248-610.1038/s41586-019-1248-6 Packard JE, Dembowski JA. HSV-1 DNA Replication–Coordinated Regulation by Viral and Cellular Factors. Viruses. 2021 Oct 7;13(10):2015. doi: 10.3390/v1310201510.3390/v13102015 Hengel H. Common Characteristics and Distinct Features of Human Pathogenic Herpesviruses. In: Sundmacher R, editor. Color Atlas of Herpetic Eye Disease. Berlin: Springer; 2009. p. 1-4. Obara Y, Furuta Y, Takasu T, et al. Distribution of herpes simplex virus types 1 and 2 genomes in human spinal ganglia studied by PCR and in situ hybridization. J Med Virol. 1997 Jun;52(2):136-142. Kim TI, Azar DT, Pavan-Langston D. Viral Disease of the Cornea and External Eye. In: Albert DM, Miller JW, Azar DT, Young LH, editors. Albert and Jakobiec’s Principles and Practice of Ophthalmology. 4th ed. Cham: Springer; 2022. p. 187-279. Knickelbein JE, Khanna KM, Yee MB, Baty CJ, Kinchington PR, Hendricks RL. Noncytotoxic lytic granule-mediated CD8+ T cell inhibition of HSV-1 reactivation from neuronal latency. Science. 2008 Oct 10;322(5899):268-271. doi: 10.1126/science.116416410.1126/science.1164164 Lobo AM, Agelidis AM, Shukla D. Pathogenesis of herpes simplex keratitis: The host cell response and ocular surface sequelae to infection and inflammation. Ocul Surf. 2019 Jan;17(1):40-49. doi: 10.1016/j.jtos.2018.10.00210.1016/j.jtos.2018.10.002 Lausch RN, Kleinschradt WR, Monteiro C, Kayes SG, Oakes JE. Resolution of HSV corneal infection in the absence of delayed-type hypersensitivity. Invest Ophthalmol Vis Sci. 1985 Nov;26(11):1509-1515. Mannis MJ, editor. Herpes Simplex Keratitis. In: Mannis MJ, Holland EJ,editors. Cornea. 2nd ed. Philadelphia: Elsevier; 2011. p. 1051- 1062. Sundmacher R, editor. Herpes Simplex Virus (HSV) Diseases of the Anterior Segment and the Adnexa. In: Sundmacher R, editor. Color Atlas of Herpetic Eye Disease. Berlin: Springer; 2009. p. 1-4. Holland EJ, Schwartz GS. Classification of herpes simplex virus keratitis. Cornea. 1999 Mar;18(2):144-154. doi: 10.1097/00003226- 199903000-0000210.1097/00003226- Wang L, Wang R, Xu C, Zhou H. Pathogenesis of Herpes Stromal Keratitis: Immune Inflammatory Response Mediated by Inflammatory Regulators. Front Immunol. 2020 May 13;11:766. doi: 10.3389/ fimmu.2020.00766 Sutcliffe E, Baum J. Acute idiopathic corneal endotheliitis. Ophthalmology. 1984 Oct;91(10):1161-1165. doi: 10.1016/s0161- 6420(84)34155-010.1016/s0161- Ashley RL. Laboratory techniques in the diagnosis of herpes simplex infection. Genitourin Med. 1993 Jun;69(3):174-183. doi: 10.1136/sti.69.3.17410.1136/sti.69.3.174 McIver CJ, Jacques CF, Chow SS, et al. Development of multiplex PCRs for detection of common viral pathogens and agents of congenital infections. J Clin Microbiol. 2005 Oct;43(10):5102-5110. doi: 10.1128/JCM.43.10.5102-5110.2005 CZECH AND SLOVAK OPHTHALMOLOGY 10.1128/JCM.43.10.5102-5110.2005 Souissi S, Fardeau C, Le HM, Rozenberg F, Bodaghi B, Le Hoang P. Chronic Herpetic Retinitis: Clinical Features and Long-Term Outcomes. Ocul Immunol Inflamm. 2018;26(1):94-103. doi: 10.1080/09273948.2017.132707910.1080/09273948.2017.1327079 Wilhelmus KR, Darougar S, Forsey T, Treharne JD. Sequential antibody changes following ulcerative herpetic keratitis. Br J Ophthalmol. 1986 May;70(5):354-356. doi: 10.1136/ bjo.70.5.354 ​ Arshad S, Petsoglou C, Lee T, Al-Tamimi A, Carnt NA. 20 years since the Herpetic Eye Disease Study: Lessons, developments and applications to clinical practice. Clin Exp Optom. 2021 Apr;104(3):396-405. doi: 10.1080/08164622.2021.187753110.1080/08164622.2021.1877531