Introduction:

LASIK (Laser-Assisted In Situ Keratomileusis) is a popular refractive surgery that corrects vision by reshaping the cornea using a laser. However, patients with a history of Herpes Simplex Virus (HSV) infection require careful consideration due to the potential risk of reactivation and complications. This article explores the factors to consider and the precautions to take when performing LASIK in patients with a history of HSV infection.

Herpes Simplex Virus and Ocular Involvement:

1. HSV-1 and HSV-2: Herpes Simplex Virus exists in two types, HSV-1 and HSV-2. HSV-1 is typically associated with oral lesions (cold sores), while HSV-2 causes genital herpes. Both types can affect the eye.
2. Herpes Keratitis: HSV can cause herpes keratitis, an inflammation of the cornea that can lead to painful and potentially vision-threatening ulcers.

Considerations for LASIK in HSV Patients:

1. History of Ocular Herpes: Patients with a history of ocular herpes must be thoroughly evaluated to determine the severity and recurrence pattern of the infection.
2. Stability of Herpes Infection: LASIK should be deferred until there has been a prolonged period of stability in the HSV infection to reduce the risk of reactivation.
3. Preoperative Antiviral Prophylaxis: Some surgeons may consider antiviral prophylaxis before LASIK to reduce the risk of reactivation during the post-operative period.
4. Epithelial Flap Creation: LASIK surgeons may choose to modify the flap creation technique to minimize the risk of disrupting corneal nerves and potentially triggering viral reactivation.
5. Patient Education: Patients should be educated about the risk of HSV reactivation and instructed to report any signs of ocular discomfort or redness promptly.

Potential Risks and Complications:

1. Reactivation of HSV: LASIK surgery can lead to transient corneal nerve dysfunction, which may increase the risk of HSV reactivation.
2. Delayed Epithelial Healing: Patients with a history of HSV keratitis may have compromised corneal healing, potentially leading to delayed epithelial healing after LASIK.
3. Corneal Sensitivity: Decreased corneal sensitivity in HSV patients may impact the perception of post-operative discomfort and dry eye symptoms.

Conclusion:

LASIK can be performed in patients with a history of HSV infection, but careful evaluation and management are essential to minimize the risk of viral reactivation and complications. Surgeons should consider the patient's medical history, the stability of the HSV infection, and the potential impact of corneal nerve dysfunction on healing. Preoperative antiviral prophylaxis and modified flap creation techniques may be employed as precautionary measures. Patients must be informed about the risks and be vigilant in reporting any ocular discomfort during the post-operative period.

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