Aspects actuels du traitement des kératites herpétiques

Herpes simplex virus is a frequent cause of keratitis. Clinical forms are usually classified as epithelial, stromal, endothelial, or neurotrophic. Management depends on the respective degrees of these various components, with some patients presenting with compound forms. In the acute phase of the disease, the therapeutic strategy is based primarily on antiviral drugs, which can be given topically or systemically, according to the level of corneal involvement (superficial or deep), its severity, and practical constraints with respect to the patient's lifestyle. Other measures may be utilized according to the type of keratitis (debridement and mydriatic eye drops in epithelial keratitis, steroids in stromal and endothelial diseases). On a longer term basis, management aims to limit the frequency of recurrences, especially if the patient is subjected to a triggering factor for viral reactivation. Preventive treatment is also based on antiviral drugs, mostly oral, with dosage that must be adapted to the patient's individual history. Other treatments may also help to reduce the frequency of recurrences, in particular topical cyclosporine, but further studies are required to better delineate such indications.