Keratitis due to Herpes simplex virus (HSK), Varicella-Zoster virus (VZK) and Cytomegalovirus remains a frequent source of concern for many ophthalmologists. They are a frequent cause of emergency consultations at eye care centers and carry the risk of permanent loss of visual acuity or visual quality and/or chronic neurotrophic keratitis, resulting in a significant decrease in the quality of life. HSK and VZK can affect the corneal epithelium, stroma, or endothelium or a combination of layers. In contrast, most cases of CMV keratitis present as isolated endothelitis (CMVE), a clinical entity that has been described within the last 2 decades. These three types of viral keratitis are characterized by a high frequency of recurrences and each new episode increases the risk of sequelae. Hence, ophthalmologists must adapt the treatment to the clinical presentation of each recurrent episode in order to mitigate the immediate consequences of viral replication and the immune response on corneal transparency. In patients with frequent recurrences, preventive long-term antiviral treatment is strongly recommended. However, in some rare cases, continuous exposure to antivirals may promote the emergence of resistant viral strains, which can be difficult to manage. In the future, the introduction of new antiviral drugs, with differing modes of action compared to current medical therapy, could be an alternative until a truly effective preventive solution, such as a vaccine, is available.

中文翻译：

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单纯疱疹病毒、水痘带状疱疹病毒和巨细胞病毒角膜炎：给临床医生的事实


单纯疱疹病毒 (HSK)、水痘带状疱疹病毒 (VZK) 和巨细胞病毒引起的角膜炎仍然是许多眼科医生经常关注的问题。它们是眼保健中心紧急咨询的常见原因，并具有永久性丧失视力或视觉质量和/或慢性神经营养性角膜炎的风险，导致生活质量显着下降。 HSK 和 VZK 可以影响角膜上皮、基质、内皮或多层的组合。相比之下，大多数 CMV 角膜炎病例表现为孤立性内皮炎 (CMVE)，这是过去 20 年来描述的一种临床实体。这三种类型的病毒性角膜炎的特点是复发频率高，每次新发作都会增加后遗症的风险。因此，眼科医生必须根据每次复发的临床表现调整治疗方法，以减轻病毒复制和免疫反应对角膜透明度的直接影响。对于经常复发的患者，强烈建议进行预防性长期抗病毒治疗。然而，在一些罕见的情况下，持续接触抗病毒药物可能会促进耐药病毒株的出现，这可能难以控制。未来，在出现真正有效的预防解决方案（例如疫苗）之前，引入与当前药物治疗相比具有不同作用方式的新抗病毒药物可能是一种替代方案。