Dr Alvarado and associates1 have contributed an interesting report on the detection of herpes simplex virus (HSV) DNA in iridocorneal endothelial (ICE) syndrome. Because they identify the positive response of one patient to antiviral therapy and suggest this as a "strong encouragement... to continue this line of investigation," we also feel strongly encouraged to identify two critical issues. First, we want to discuss the interpretation of the data. Second, we want to discuss the use of this information to guide the management of patients.
Herpesviruses, including HSV, are noted for their ubiquitous nature. Because of this fact, one must be especially cautious when these viruses are identified as etiologic agents. Dr Alvarado and colleagues state that "[t]his strong association is likely to be etiologic because viral DNA is not detected in controls with other chronic diseases or ostensibly normal corneas." This is an exceptionally strong statement in light of
Hooks JJ, Kupfer C. Herpes Simplex Virus in Iridocorneal Endothelial Syndrome. Arch Ophthalmol. 1995;113(10):1226-1227. doi:10.1001/archopht.1995.01100100014006