The TREATMENT of herpes simplex virus (HSV) infections of the eye has been controversial for many years. One unresolved issue involves the use of corticosteroids in the treatment of HSV stromal keratitis. A second issue relates to the use of the potent antiviral, acyclovir, which has been demonstrated to be effective in preventing recurrences of HSV genital infections.1 Now the results of two placebo-controlled therapeutic trials have addressed these two issues in the management of herpes simplex eye disease.2,3
TOPICAL CORTICOSTEROIDS FOR HSV STROMAL KERATITIS
To evaluate topical corticosteroids, nine clinical centers in the United States recruited 106 patients with active HSV stromal keratitis, no epithelial defect, and no steroid treatment for at least 10 days.2 Forty-nine patients were randomized to treatment with placebo and 57 patients to topical prednisolone phosphate drops. In a standardized regimen, the prednisolone (and placebo) drops were progressively decreased over a 10-week