Herpes and Zoster infections update

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Herpes Simplex Virus (HSV) and Varicella-zoster Virus (VZV) are the two leading causes of infectious acquired amblyopia. After a phase a latent infection in the trigeminal ganglia, they may reactivate to eventually infect the cornea. There are several common features of keratitis due to HSV or VZV. The most frequent forms involve the epithelium, with 4 different patterns: punctuate and diffuse, dendritic, geographic, and marginal. Stromal forms of keratitis are mostly non-necrotic, and usually resolve with a combination of oral antivirals and topical steroids. In contrast, a necrotic stromal keratitis usually requires intravenous antiviral therapy. Endothelial forms of HSV/VZV keratitis are far less frequent. Three different types may be observed: disciform, diffuse or linear, the latter one being the most aggressive. After the acute phase of HSV/VZV keratitis, preventive treatment with oral antivirals may be given according to the clinical history. For VZV, a vaccine is now available. Its effectiveness has been shown for the prevention of herpes zoster ophthalmicus, but its place in patients with recurrent VZV infections of the eye remains to be clarified.

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