Don’t rule out HSV patients for refractive surgery
I am staunch supporter of refractive surgery. In fact, in my evaluation of potential candidates for refractive surgery I boldly express that every patient can have refractive surgery. Yes, I said it. Everyone can lie down, expose the stromal tissue, and have a laser reshape the tissue for the betterment of visual acuity—or not.
Not every patient is going to get a great result. The caveat to the “everyone is welcome to the refractive party” is that not everyone is an ideal candidate. When we preselect these patients, it is important to filter out those patients who are potential high risk. Through the years, we have really honed in on those patients.
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However, we are wrongly biased against one subset of our population—those with herpes simplex virus (HSV). I am speaking to my patients who have any type of ocular herpetic virus. Let’s support those patients who have herpetic virus and want to liberate themselves from glasses or contact lenses.
It is not a secret that corneal refractive surgery induces trauma to the cornea, plus it requires exposure to ultraviolet light which potentially can reactivate a dormant virus. The key word in that sentence is “potential” because it is not a certainty that the virus will be set into motion. More to the point, reactivation of the virus can increase complications from the procedure, creating problems such as corneal scarring, loss of vision, secondary glaucoma, and corneal thinning and perforation.
Research has shown that strictly having the dormant virus does not prompt the activation process. The causes of reactivation are uncertain, but several potential triggers have been documented. Changes in the immune system during menstruation may play a role in HSV-1 reactivation.1 Concurrent infections, such as viral upper respiratory tract infection or other febrile diseases, can cause outbreaks. Reactivation due to other infections is the likely source of the historic terms “cold sore” and “fever blister.” Other identified triggers include local injury to the face, lips, eyes, or mouth; trauma; surgery; radiotherapy; and exposure to wind, ultraviolet light, or sunlight.1,2