Purchase this article with an account.
P. Bhat, F. A. Jakobiec, K. Kurbanyan, T. Zhao, C. S. Foster; Histopathologic Diagnosis and Management of Herpetic Scleritis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):299.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Infectious scleritis due to herpes is unusual, requires high degree of clinical suspicion, and special immunohistopathologic techniques for diagnosis. We describe the clinical features, immunopathologic findings and management of 9 cases of biopsy-proven scleritis due to herpes simplex virus (HSV) which have not been previously reported in a series.
This study was a retrospective case series of nine patients who had recalcitrant simple, diffuse, or nodular anterior scleritis and who underwent a biopsy (8 scleral and 1 conjunctival biopsy) for the detection of HSV antigen. Negative controls included absence of positive staining with anti-HSV / anti-VZV antibody in normal human conjunctiva/sclera and the absence of positive staining anti-VZV antibody in the patients’ specimens. Data regarding clinical features were collated. Scleral/ conjunctival tissue was fixed in Karnovsky solution or 10% buffered formalin, embedded in plastic or paraffin, respectively and stained with hematoxylin and eosin (H&E). Immunohistochemistry studies were performed on snap frozen OCT embedded tissue to ascertain the presence of HSV antigen within the scleral/conjunctival tissues. Response to therapy with acyclovir was recorded.
The average age of the affected patients was 50.2 ± 12.8 years, and the average duration of symptoms prior to the diagnosis of herpetic scleritis was 3.4 years. Granulomatous inflammation, irritated fibroblastic (pseudosarcomatous) reactions with abundant accompanying lymphocytes and plasma cells, polymorphous non-granulomatous inflammatory infiltrates with a scarifying fibroblastic repair response, and a pyogenic granuloma pattern with plentiful plasma cells were observed. Immunohistochemical probing with anti-HSV antibody disclosed patchy stromal and perivascular staining indicative of the presence of HSV antigen within all biopsied tissues. Negative control probings were all negative. Acyclovir caused a dramatic resolution in scleritis in each instance.
Herpes simplex virus can cause longstanding cryptic scleritis .Tissue analysis, which can also usefully include the overlying conjunctiva, is required to establish a definitive diagnosis directing therapy to institution of systemic acyclovir. Histopathologic features are varied, and definitive diagnosis depends on immunofluorescent tissue identification of HSV antigen in affected tissue.
This PDF is available to Subscribers Only