Feline Herpesvirus-1: Ocular manifestations, diagnosis and treatment options

Practical relevanceFeline herpesvirus-1 (FHV-1) is a major cause of feline morbidity. Following exposure to the virus, virtually all cats become persistently infected and many of these will develop recrudescent disease on one or more occasions during their lifetime. Acute ocular herpetic disease manifests as conjunctivitis, corneal ulceration and keratitis, and can be severe and painful. Repeated bouts of recrudescent ocular disease can lead to progressive corneal pathology that can be ultimately blinding in affected cats.Global importanceFHV-1 has a worldwide distribution, with reported exposure rates in some cat populations of up to 97%. As such it is a significant cause of clinical disease in the global cat population.Patient groupYoung and adolescent cats are most at risk of acute primary disease, and the vast majority of these will become persistently infected. Around half of all persistently infected cats will shed virus at some stage in their life and these may develop recrudescent ocular disease.Clinical challengesTreatment of FHV-1 ocular disease is challenging. Antiviral medications may be expensive, and require good owner and patient compliance. Clinical responses in patients can be variable. Selecting the appropriate therapeutic approach requires good clinical judgement, with assessment of factors such as severity and stage of clinical disease, patient and owner compliance, and financial considerations.Evidence baseAlthough a wide range of antiviral treatments is available, few have been tested in controlled clinical trials. Therapeutic decisions are, therefore, often based on results of in vitro studies, case-based reports and anecdote. Large, masked, controlled clinical trials are required in order to determine the efficacy of the antiviral drugs currently available to treat FHV-1.