Herpes simplex keratitis:A brief clinical overview

The aim of our minireview is to provide a brief overview of the diagnosis,clinical aspects,treatment options,management,and current literature available regarding herpes simplex keratitis(HSK).This type of corneal viral infection is caused by the herpes simplex virus(HSV),which can affect several tissues,including the cornea.One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea.After the initial infection,the HSV can establish a latent infection in the trigeminal ganglion,a nerve cluster near the eye.The virus may remain dormant for extended periods.Periodic reactivation of the virus can occur,leading to recurrent episodes of HSK.Factors triggering reactivation include stress,illness,immunosuppression,or trauma.Recurrent episodes can manifest in different clinical patterns,ranging from mild epithelial involvement to more severe stromal or endothelial disease.The severity and frequency of recurrences vary among individuals.Severe cases of HSK,especially those involving the stroma and leading to scarring,can result in vision impairment or even blindness in extreme cases.The cornea's clarity is crucial for good vision,and scarring can compromise this,potentially leading to visual impairment.The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization.Antiviral medications,such as oral Acyclovir or topical Ganciclovir,may be prescribed for prophylaxis.The immune response to the virus can contribute to corneal damage.Inflammation,caused by the body's attempt to control the infection,may inadvertently harm the corneal tissues.Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation.In summary,the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.

Bilateral meibomian gland morphological alterations in unilateral herpes simplex keratitis based on artificial intelligence analysis

AIM:To explore whether unilateral herpes simplex keratitis(HSK)can cause morphological changes of bilateral meibomian glands(MGs)based on artificial intelligence(AI)analytical system.METHODS:In the retrospective study,29 patients with unilateral HSK and 29 participants matched in terms of age and sex were included as control group.Meibographic images of the upper eyelid using Keratograph 5M and assessed ocular surface parameters including tear meniscus height and tear break-up time.MG density and vagueness values were automatically analyzed and calculated using an AI analytical system.We compared the differences between the affected and the contralateral unaffected eyes in HSK patients,and the normal control eyes.We employed either the paired t-test or the Wilcoxon signed-rank test to compare significant difference between the affected and unaffected eyes in HSK patients or between the HSK group and control group.RESULTS:The MG density was 0.19±0.09 in the HSKaffected eye and 0.18±0.07 in contralateral unaffected eye,which had no significant difference(P=0.616).The MG density between the affected eye with HSK and the normal control group was statistically significant(P=0.028).There was a significant difference in MG density between the contralateral unaffected eye and the normal control group(P=0.012).However,no significant difference in vagueness value was observed between the eye with HSK and the control group or between HSK eye and contralateral eye.CONCLUSION:The MG density between the HSKaffected eye and the contralateral unaffected eye don’t significantly differ,whereas there is a significant decrease in the HSK group compared to that of the normal participants.Unilateral HSV keratitis may suffer from bilateral changes of MG morphology indicating bilateral dry eye.Therefore,the fellow eye of patients with unilateral HSK should be considered a potential case of MG dysfunction,necessitating early treatment for bilateral dry eye in the clinic.

Virus DNA Detection of Herpes Simplex Keratitis by PCR

HSV-DNA of seven corneal lesions suspected with herpessimplex keratitis (HSK) and nine normal human donor corneas weredetected by PCR,Five out of seven diseased corneas showed positiveresults,and the other two diseased corneas and nine.normal corneasnegative.The results suggest the PCR may be useful as a rapid andsensitive method for diagnosing HSK.Eye Science 1993;9:126-128.

Effects of integrated traditional Chinese and western medicine on the vision recovery and serum trace elements of patients with herpes simplex keratitis

Objective:To explore the effects of integrated traditional Chinese and western Medicine on the vision recovery and serum trace elements in patients with herpes simplex keratitis.Methods:A total of 86 cases of HSK patients admitted in Baogang Hospital of Inner Mongolia from January 2015 to October 2016 were selected and divided randomly into the observation group(n=43)and the control group(n=43)according to the random number table.The control group was treated with ganciclovir eye drops and chondroitin sulfate eye drops,and the observation group was treated with Qinggan Mingmu Decoction on the basis of the control group.The 2 groups were treated for 4 weeks continuously.The clinical efficacy was compared between two groups.The vision recovery,serum trace elements and tear immune factor levels were also compared between two groups before and after treatment.Results:After treatment,the effective rate of treatment in the observation group was significantly higher than that in the control group(p<0.05);in the observation group of patients,visual analogue scale(VAS)score and visual acuity after treatment were obviously higher than those before treatment,and also remarkably higher than those in the control group of patients(p<0.05);after treatment,the levels of Fe,Ca and Cu ions in the observation group were significantly lower than those in the control group and before treatment(p<0.05);after treatment,the level of zinc ions in the serum in the observation group was significantly higher than that before treatment and in the control group(p<0.05);after treatment,the levels of tear IgA,IgG and C3 in the observation group were prominently higher than those before treatment and in the control group(p<0.05).Conclusions:In the treatment of HSK,integrated traditional Chinese and western medicine can promote effectively the vision recovery,regulate the level of trace elements in the serum and enhance the level of tear immune factors,with the clinical efficacy better than the treatment of western medicine alone.

The role of adhesion molecules ICAM-1 and VCAM-1 in herpes simplex keratitis

Purpose:To elucidate the role of adhesion molecules in the pathogenesis of herpes simplex keratitis. Methods:Fifty female Balb/c mice (4-6 weeks old, 14-22 g weight) were divided into two groups randomly. Forty were infected by herpes simplex virus and the other 10 were used as normal controls.All mice were fed under the same conditions.Corneas of these mice were collected for immunohistochemical testing on day 14 and 21 after infection. Results:ICAM-1 was mainly expressed in the basal cells of the corneal epithelia and vascular endothelia of the infected mice. A substantial amount of VCAM-1 was also expressed in the corneal vascular endothelial cells of infected mice,and was also found in inflammatory cells in the epithelial and stromal layers of the corneas. Conclusion:Adhesion molecules ICAM-1 and VCAM-1 were involved in the progression of herpex simplex keratitis.They may accelerate the progress of inflammation by mediating the extravsation of inflammatory cells from vessels into the infected sites.

DNA vaccine expressing herpes simplex virus 1 glycoprotein C and D protects mice against herpes simplex keratitis

AIM： To investigate whether DNA vaccine encoding herpes simplex virus 1（HSV-1） glycoprotein C（g C） and glycoprotein D（g D） will achieve better protective effect against herpes simplex keratitis（HSK） than DNA vaccine encoding gD alone. METHODS： DNA vaccine expressing gD or gC combined g D（g D.g C） were constructed and carried by chitosan nanoparticle. The expression of fusion protein gD and gC were detected in DNA/nanoparticle transfected 293 T cells by Western-blot. For immunization, mice were inoculated with DNA/nanoparticle for 3 times with 2 wk interval, and two weeks after the final immunization, the specific immune responses and clinical degrees of primary HSK were evaluated. RESULTS： Fusion protein g D.g C could be expressed successfully in cultured 293 T cells. And, p RSC-g C.g DIL21 DNA/chitosan nanoparticle could effectively elicit strongest humoral and cellular immune response in primary HSK mice evidenced by higher levels of specific neutralizing antibody and s Ig A production, enhanced cytotoxicities of splenocytes and nature killer cells（NK）,when compared with those of gD alone or mocked vaccine immunized mice. As a result, gC-based vaccine immunized mice showed least HSK disease. CONCLUSION： gC-based DNA vaccine could effectively prevent the progress of primary HSK, suggesting that this DNA vaccine could be a promising vaccine for HSK treatment in the future.

Systemic IL-1β production as a consequence of corneal HSV-1 infection-contribution to the development of herpes simplex keratitis

This study sought to identify potential therapeutic targets in herpes simplex keratitis(HSK) patients with active and inactive infection by investigating peripheral cytokine production. Peripheral blood mononuclear cells(PBMCs) and serum were prepared from healthy controls and HSK patients during active infection or following treatment(inactive infection). Serum antibody titres were determined by ELISA. Protein expression levels were analysed by Western blot. Cytokine levels were determined by multiplex ELISA. Active corneal herpes simplex virus type 1(HSV-1) infection resulted in significantly elevated peripheral levels of IL-1β in HSK patients compared to healthy controls, and remained significantly increased following treatment. Elevated production of IL-1β in inactive patients was associated with significantly increased levels of IRF3 and STAT1, key proteins involved in promoting anti-viral immune responses. Our data suggest that inflammation persists beyond the period that it is clinically evident and that enhanced peripheral production of IL-1β may have implications for HSV-1 viral clearance in active and inactive HSK patients.

A Comparison of the Clinical and Molecular Diagnosis of Herpes Simplex Keratitis

Purpose: To compare the clinical and molecular diagnoses of Herpes Simplex Keratitis (HSK). Materials and Methods: Conjunctival swabs (after fluorescein and anaesthetic wash out) and detailed questionnaire data were obtained from 146 participants. Corneal rims and conjunctival epithelial cells were infected with Herpes Simplex Virus (HSV) type 1 or HSV2 and supernatant collected. HSV1;HSV2;Varicella Zoster Virus (VZV) and Adenovirus (ADV) DNA was assessed using two real time Polymerase Chain Reaction (PCR) methods. Results: Of the 146 participants recruited, 54 were clinically diagnosed with typical epithelial lesions and 38 with atypical epithelial lesions, 17 with old inactive HSK and 37 healthy volunteers. HSV1 DNA was detected in 28 (30%) of the 92 participants with clinically suspect HSK. Patients who presented with typical epithelial lesions had a higher positive rate (46%) than those who presented with atypical type lesions (8%), when using primers against the Glycoprotein (Gp) G region of the virus. When the same samples were retested with primers against the GpB region, the positive rate for the typical and atypical cases increased to 52% and 11% respectively. Antiviral use at the time of sampling reduced the rate of PCR positivity by 20% (p < 0.05). ADV DNA was detected in 6% of the typical cases and 8% of the atypical cases. All control participants with no history of HSK were negative for HSV1 DNA. Sample quantity was confirmed by testing for housekeeping control genes, beta-actin and beta-2 macroglobulin. PCR results from in vitro control investigations of HSV1 and 2 infected corneal rims and conjunctival epithelial cells were 100% positive for infected and 100% negative for uninfected samples when assessed using both PCR methods. Conclusions: Clinical diagnosis of typical HSK is not always confirmed by PCR. Concomitant use of an antiviral reduces levels of PCR positivity. Given this and the findings that other ocular surface pathogens may mimic HSK pathology, and that choice of gene amplification region can also affect accurate detection of HSV1 by PCR, we propose the use of a multiplex assay. This would perform PCR using primers spanning a number of different regions within one gene and would also target a number of different viral genes to ensure potentially different HSV1 viral strains or other viruses do not affect the test and lead to disagreements between the clinical and molecular diagnosis of HSK. From these findings, this paper proposes a clinical supportive algorithmic guide to manage such disagreements.

Clinical Efficacy of Oral Ganciclovir for Prophylaxis and Treatment of Recurrent Herpes Simplex Keratitis

Background：Herpes simplex keratitis （HSK） caused by herpes simplex virus 1 （HSV-1）,which has high recurrent rate and incidence of severe vision loss,is the leading cause of infectious blindness in the world.The aim was to explore the clinical efficacy of oral ganciclovir （GCV） in the prevention of recurrent HSK.Methods：A multicenter,prospective,randomized,single-blind,and controlled clinical trial was conducted from April 2010 to June 2013.One hundred seventy-three patients （173 eyes involved） who were diagnosed as recurrent HSK definitely,including stromal keratitis and corneal endotheliitis,were divided into three groups randomly：negative control （placebo） group was topically administered with 0.15% GCV ophthalmic gel,4 times per day and 0.1% fluorometholone eye drops,3 times per day until resolution of HSK; positive control acyclovir （ACV） group was topically adopted the same ophthalmic gel and eye drops and additionally received oral ACV 400 mg 5 times a day for 10 weeks and followed by 400 mg 2 times per day for 6 months; test GCV group was topically adopted the same treatment as negative control group and additionally received oral GCV 1000 mg 3 times per day for 8 weeks.The symptoms and signs were evaluated before and after the therapy 1^st week,2^nd week and then followed up every 2 weeks until recovery.Furthermore,we followed up recurrence of HSK for every 3 months after recovery and then assessed the cure time,recurrent rate and adverse reactions.Results：One hundred and seventy-three patients were followed up 7-48 months （mean 32.1 ± 12.3 months）,but 34 patients were failed to follow-up.The cure time was 12.1± 4.3,11.9 ± 4.0 weeks in negative control （placebo） group and positive control ACV group respectively （P =0.991）,which was longer than that in test GCV group （8.6 ± 2.8 weeks） and there was a significant difference between test GCV group and negative control （placebo） group or positive control ACV group （P =0.000）.Furthermore,the recurrent rate was higher in negative control （placebo） group （47.3%） than that in positive control group ACV （26.7%） and test GCV group （17.2%）,and there was a great significant difference among the three groups （P =0.007）,but there was no significant difference between positive control ACV group and test GCV group （P =0.358）.In addition,there was no obvious adverse reaction expect neutropenia （only one patient in test GCV group）.Conclusion：Short-term oral GCV could cure recurrent HSK and endotheliitis,shorten the course,reduce recurrent rate of HSK and have confirmed safety.

Corneal esthesiometry and sub-basal nerves morphological changes in herpes simplex virus keratitis/uveitis patients

AIM: To describe and compare corneal sensation and morphological changes of sub-basal corneal nerves by in vivo laser scanning confocal microscopy(LSCM) in herpes simplex virus(HSV) keratitis/uveitis and contralateral, clinically unaffected eyes. METHODS: A prospective clinical study included 30 HSV eyes and 30 contralateral eyes of 30 patients, diagnosed with unilateral HSV keratitis/uveitis. Both eyes underwent a complete ophthalmological examination, Cochet-Bonnet aesthesiometry and LSCM of the central cornea, using the Heidelberg Retina Tomograph III Rostock Cornea Module. After 6 mo, the same examination of the HSV affected and contralateral, clinically unaffected eyes was performed.RESULTS: HSV eyes, as compared to contralateral eyes, demonstrated a significant decrease in mean corneal sensation(3.1±1.6 vs 5.3±0.8 cm), total nerve fibres number(5.7±4.4 vs 15.1±5.4), nerve branches(3.4±3.0 vs 8.4±4.7), main nerve trunks(2.3±1.6 vs 5.8±2.2), and nerve fibres density(7.5±5.6 vs 18.1±5.3 mm/mm2, P<0.05). There was no significant difference between keratitis and uveitis eyes in mean corneal sensation and nerve fibres parameters. After 6 mo, corneal sensation and sub-basal nerve fibres parameters were increased significantly, but did not reach the parameters of contralateral, clinically unaffected eyes.CONCLUSION: Corneal aesthesiometry and LSCM in HSV affected eyes reveals a significant decrease of corneal sensation and sub-basal nerve fibres which recovers at6 mo but does not reach the normal level.

Herpes simplex virus-1 infection or Simian virus 40-mediated immortalization of corneal cells causes permanent translocation of NLRP3 to the nuclei

AIM: To investigate into the potential involvement of pyrin containing 3 gene(NLRP3), a member of the nucleotide-binding oligomerization domain-like receptors with cytosolic pattern recognition, in the host defense of corneas against viruses.METHODS: The herpes viral keratitis model was utilized in BALB/c mice with inoculation of herpes simplex virus-1(HSV-1). Corneal tissues removed during therapy of patients with viral keratitis as well as a Simian vacuolating virus 40(SV40)-immortalized human corneal epithelial cell line were also examined.Immunohistochemistry was used to detect NLRP3 in these subjects, focusing on their distribution in tissue or cells. Western blot was used to measure the level of NLRP3 and another two related molecules in NLPR3 inflammasome, namely caspase-1 and IL-1β.RESULTS: The NLRP3 activation induced by HSV-1infection in corneas was accompanied with redistribution of NLRP3 from the cytoplasm to the nucleus in both murine and human corneal epithelial cells. Furthermore,in the SV40-immortalized human corneal epithelial cells,NLRP3 was exclusively located in the nucleus, and treatment of the cells with high concentration of extracellular potassium(known as an inhibitor of NLRP3activation) effectively drove NLRP3 back to the cytoplasm as reflected by both immunohistochemistry and Western blot.· CONCLUSION: It is proposed that herpes virus infection activates and causes redistribution of NLRP3 to nuclei. Whether this NLRP3 translocation occurs with other viral infections and in other cell types merit further study.

Anti-viral activity of Staphylococcus aureus lysates against herpes simplex virus type-Ⅰinfection:an in vitro and in vivo study

AIM:To investigate the effect of Staphylococcus aureus(S.aures)lysates(SALs)on herpes simplex virus type-Ⅰ(HSV1)infection in human corneal epithelial(HCE)cells and in a mouse model of HSV1 keratitis.METHODS:HCE,Vero,HeLa,and BV2 cells were infected with HSV1[HSV1f strain,HSV1f;HSV-1-H129 with green fluorescent protein(GFP)knock-in,HSV1g].Pre-or post-infection,SAL at various concentrations was added to the culture medium for 24 h.GFP fluorescence in HSV1g or plaque formation by HSV1f were examined.The effects of heat-treated SAL,precooled acetone-precipitated SAL,and SAL subjected to ultrafiltration(100 kDa)were evaluated.The effects of other bacterial components and lysates on HSV1 infection were also tested,including lipoteichoic acid(LTA),peptidoglycan(PGN),staphylococcal protein A(SPA),andα-hemolysin from S.aureus(α-toxin)as well as lysates from a wild-type S.aureus strain,S.epidermidis,and Escherichia coli(W-SAL,SEL,and ECL,respectively).In addition,SAL eye drops were applied topically to BALB/c mice with HSV1 keratitis,followed by in vivo observations.RESULTS:The cytopathic effect,plaque formation(HSV1f),and GFP expression(HSV1g)in infected cells were inhibited by SAL in a dose-dependent manner.The active component of SAL(≥100 kDa)was heat-sensitive and retained activity after acetone precipitation.In HSV1ginfected cells,treatment with LTA-sa,α-toxin,PGN-sa,or SPA did not inhibit GFP expression.SAL,W-SAL,and SEL(but not ECL)decreased GFP expression.In mice with HSV1 keratitis,SAL reduced corneal lesions by 71%.CONCLUSION:The results of this study demonstrate that SAL can be used to inhibit HSV1 infection,particularly keratitis.Further studies are needed to determine the active components and mechanism underlying the effects of SAL.

现代医学和传统医学对复发性HSK的研究进展

从近年来大量的研究文献可以看出,复发性单纯疱疹病毒性角膜炎一直是眼科学研究的一个热点,其发病机制及治疗药物的探索早已成为研究的焦点。随着医学研究的深入,我们对单纯疱疹性角膜炎有了新的认识,但目前对其具体发病机制和治疗手段尚不一致,还需进一步研究。

多重聚合酶链反应快速诊断HSK和真菌性角膜炎的研究

目的:探讨多重聚合酶链反应(multiplexPCR,MPCR)技术快速诊断单纯疱疹病毒性角膜炎(HSK)和真菌性角膜炎的价值。方法:建立单纯疱疹病毒(HSV)和致病性真菌菌株的MPCR检测方法,检测49例患者54眼角膜刮片或泪液标本,对怀疑为真菌和混合感染的与涂片镜检和真菌培养比较。结果:MPCR5h可检测出标本中微量HSV和真菌,54份标本MPCR检测阳性43份(80%),其中怀疑有真菌感染的25份标本中17份真菌检测阳性(68%),阳性率明显高于真菌培养(χ2=11.57,P<0.005)和涂片镜检(χ2=13.33,P<0.005)。结论:MPCR速度快、敏感性和特异性高,有助于HSK和真菌性角膜炎的快速明确诊断。

HSK合并白内障行超声乳化术后的疗效及临床用药观察

目的:观察单纯疱疹病毒性角膜炎(Herpes simplex keratitis,HSK)合并白内障患者行白内障超声乳化术后视力变化及术后应用抗病毒药物预防单纯疱疹病毒性角膜炎复发的疗效。方法:单纯疱疹病毒性角膜炎合并白内障22例22眼行白内障超声乳化+人工晶状体植入术,术后随机分为两组,治疗组给予口服阿昔洛韦及滴用更昔洛韦凝胶;对照组仅给予滴用更昔洛韦凝胶。观察术后视力变化情况;分析单纯疱疹病毒性角膜炎复发的情况。结果:术后6mo随访,治疗组和对照组视力均获得提高;治疗组无1例出现单纯疱疹病毒性角膜炎的复发;对照组也仅有1例于术后6mo复发,差异无显著性。结论:在抗病毒药物的保护下,>6mo未复发的单纯疱疹病毒性角膜炎不是白内障的手术禁忌,白内障手术能有效改善HSK合并白内障患者的视力;仅滴用更昔洛韦凝胶亦能有效预防白内障术后单纯疱疹病毒性角膜炎的复发。

羊膜移植对实验性HSK中基质金属蛋白酶表达的影响

目的研究羊膜移植(AMT)对单纯疱疹性角膜炎(HSK)中基质金属蛋白酶(MMP-2,-9)表达的影响。方法40只BALB/c小鼠角膜感染Ⅰ型单纯疱疹病毒(HSV-1),实验组角膜行AMT。术后第0、2、7、14 d取出角膜。常规病理切片、免疫组化染色和计算机图像分析检测角膜中MMP-2及-9的表达及平均光度值的变化。结果对照组20只鼠眼中17只发生HSK;AMT组仅有9只眼发生,差异有显著统计学意义(P<0.01)。AMT组角膜上皮、基质病变程度及新生血管发生率明显低于对照组(P<0.05)。免疫组化及图像分析显示对照组角膜细胞和浸润炎性细胞中表达的MMP-2及-9在第2 d增加,14 d时达高峰。AMT组各时间点MMP-2及-9表达低于对照组,差异有显著统计学意义(P<0.05)。结论羊膜移植可能通过抑制角膜细胞及浸润的炎症细胞产生MMPs,从而抑制HSK的发生和发展。

抗HSV单克隆抗体－阿糖胞苷特异性导向药物的制备及对实验性HSK的疗效观察

本文报道了抗ＨＳＶＭｃＡｂ与抗病毒药物阿糖胞苷偶联物的制备及鉴定。首先用高碘酸钠氧化葡聚糖为多醛基葡聚糖，使之作为中间载体将阿箱胞苷与ＭｃＡｈ偶联，经鉴定偶联物中ＭｃＡｂ含量为１０ｍｇ／ｍｌ，阿糖胞苷含量为１．０５ｍｇ／ｍｌ，阿糖胞苷与ＭｃＡｂ的充分子比为１：６０，偶联物的ＥＬＩＳＡ效价为１：２５６与偶联前效价相同。应用偶联物和阿糖胞苷分别结膜下注射治疗免眼ＨＳＫ模型共３６只眼，表明偶联物的疗效优于阿糖胞苷。

荧光定量PCR技术检测HSK房水中HSV-Ⅰ型DNA

目的探讨荧光定量聚合酶链反应(FQ-PCR)技术对I型单纯疱疹病毒性角膜炎(HSK)的病原学诊断价值。方法应用FQ-PCR技术对HSK患眼房水中的I型单纯疱疹病毒(HSV-I)DNA进行扩增,并对PCR产物进行定量检测,同时以老年性白内障患者房水作为对照,并作统计学分析。结果 16例(16只眼)HSK患眼房水中有5例阳性,阳性率31.25%,20例(20只眼)单纯老年性白内障患者房水无1例阳性,阳性率0%,差异有统计学意义(P<0.05)。结论 FQ-PCR法可以作为HSK的病原学快速诊断的实验室方法之一。

HSK的包膜糖蛋白gB和gD与疫苗的研究新进展

包膜糖蛋白gB,gD是参与单纯疱疹病毒(herpes simplex virus,HSV)感染的基本结构蛋白,具有重要的抗原表位,参与病毒穿膜过程,介导了病毒的细胞间扩散,在病毒感染和宿主免疫过程中起着重要作用,其分子和功能特性的研究对HSV作用机制及预防的研究有着重要意义。近年来,该领域的研究取得一定进展,针对HSVgB,HSVgD的抗原表位已研究出相应疫苗,本文将对与单纯疱疹病毒性角膜炎(herpes simples keratitis,HSK)有关的糖蛋白gB,gD与疫苗的研究进展做一简要综述。

郭承伟教授治疗病毒性角膜炎经验举隅

病毒性角膜炎是临床常见的感染性角膜病,以单纯疱疹病毒性角膜炎最为常见。临床表现为畏光流泪,沙涩疼痛,黑睛生翳,可伴有乏力、自汗、恶风、畏寒、易感冒、体质弱等,多次发作可形成角膜新生血管及斑翳,甚至导致失明。本病发病率和复发率高,具有致盲性,至今仍无统一治疗手段。中医药以独特优势和显著疗效,已成为病毒性角膜炎的优先治疗手段。郭承伟教授长期从事中医眼科临床工作,具有深厚的中医理论功底和丰富的临床经验,针对眼自身的生理病理特点,形成了完善的病毒性角膜炎诊疗思路。在重视“翳自热生”的角膜炎中医发病机制的基础上,又特别强调目为清窍,清阳灌目是视瞻和抵御外邪的关键。认为黑睛生翳早期,以外感风热为主,治疗强调发散祛邪,祛风为先,风散则火热无所依附,翳退目自明。同时,用药重视辛温发散、寒热并用,既能增强发散祛邪之功,又可避免凉遏之弊;重视将整体辨证与局部辨证相结合,遵守扶正祛邪,标本兼治的原则。郭承伟教授针对不同个体,坚持辨病与辨证相结合的思想,能够切中病症关键,效如桴鼓,体现了郭承伟教授知常达变,“临证察机,使药要和”的辨治理念,对临床诊疗具有良好的指导意义。