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H. Boisjoly, A. Simard-Lebrun, A. Al-Saadi, M. Mabon, J. Choremis; Association Between Unilateral Quiescent Stromal Herpetic Keratitis and Bilateral Dry Eye. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4678.
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According to our clinical observation, patients with quiescent herpetic stromal keratitis often seem to present signs of dry eye in the contralateral eye. Keijser et al has shown that steady state tear turnover was two times lower in patients with latent stromal herpetic keratitis than in healthy control subjects (IOVS 2002;43:87-91). Our goal was to compare dry eye signs and symptoms in both eyes of patients with quiescent stromal herpetic keratitis to those of age and gender matched control subjects with healthy corneas.
We conducted a case-control study with 25 subjects per group (50 subjects total, as per sample-size calculation).
The average age of 10 men and 15 women in each group was 58.8 years for cases and 58.4 for controls. First, the HSV eye of cases was compared to the contralateral eye with a healthy cornea. As expected, the HSV eye had significantly less corneal sensation as measured with the Cochet-Bonnet esthesiometer (p=0.001); no significant difference was however found for Schirmer tests done without anesthesia and with anesthesia (basal secretion), tear break-up time, conjunctival fluorescein staining, mucus and debris in the tear film, and eyelid margin redness or swelling. Second, a comparison of the two eyes of control subjects with healthy corneas showed no significant difference for all measured parameters of dry eye. Third, the HSV eye of cases was compared to the right eye of controls while the healthy eye of cases was compared to the left eye of controls. Patients with unilateral quiescent stromal HSV had significantly lower bilateral Schirmer tests both without anesthesia (p=0.02) and with anesthesia (p=0.001, basal secretion), and conjunctival fluorescein staining (p=0.001) than eyes of controls. Dry eye symptoms of cases and controls did not differ significantly.
Both eyes of patients with quiescent stromal herpetic keratitis are dry even if many HSV patients do not have symptoms in their contralateral eye. It is important to look for signs of bilateral dry eye in patients with quiescent herpetic stromal keratitis to prevent additional morbidity and vision loss.
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