Tear secretion impairment as a function of severity of herpetic keratitis

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To assess the quality of tear secretion in eyes of patients with a history of unilateral and recurrent herpetic keratitis


33 patients with a history of recurrent herpetic keratitis (either archipelago keratitis, KA, or kerato-uveitis, KU, or neurotrophic keratitis, KN) were compared with 33 normal subjects. A complete ophthalmologic examination was performed, with successively the assessment of tear osmolarimetry, tears break-up time (TBUT), Schirmer I test, and corneal sensitivity. Patients with other potential causes of abnormal tears were excluded, and all tests were performed at least 3 months after the last relapse of keratitis. Controls were selected among asymptomatic patients scheduled for cataract surgery or refraction disorders, and were matched for age and gender with patients.


The patients group (19 men, 14 women, aged 52 ± 7 years) included 16 patients with KA, 13 with KU, and 6 with KN. In the control group (similar sex ratio and mean age), all tests were symmetrical between the two eyes. In the 3 groups of patients, tear osmolarimetry was significantly greater in affected eyes than in controls, as well as TBUT was significantly reduced. In contrast, Schirmer I test was reduced only in eyes of patients with a history of KU or KN. Finally, only KN eyes were statistically less sensitive than healthy eyes.


Recurrent herpes keratitis induced changes in lacrimal secretion, even when the disease is apparently quiescent, and the abnormalities are more important as the corneal disease is progressing In the context of our study, tear hyperosmolarity appeared to be a particularly sensitive test to detect impairment of tear secretion.

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