Herpes Simplex Virus
Herpes simplex virus (HSV) is a member of the herpesvirus family, which includes 2 types of simplex virus (HSV-1 and HSV-2), herpes zoster, Epstein-Barr virus, and CMV. Neonatal HSV infection occurs in 1 in 3000 to 20,000 births and is usually secondary to HSV-2. HSV-1 typically affects the eyes, skin, and mouth region and is transmitted by close personal contact. HSV-2 is typically associated with genital infection through venereal transmission.
Congenital HSV infection is usually acquired during passage through an infected birth canal. The neonatal infection is confined to the CNS, skin, oral cavity, and eyes in one-third of cases. It commonly manifests with vesicular skin lesions, ulcerative mouth sores, and keratoconjunctivitis. Disseminated disease occurs in two-thirds of cases and can involve the liver, adrenal glands, and lungs. Eye involvement in congenital infection can include conjunctivitis, keratitis, retinochoroiditis, and cataracts. Keratitis can be epithelial or stromal. Retinal involvement can be severe and may include massive exudates and retinal necrosis.
Affected infants are treated with systemic acyclovir. The mortality rate from disseminated disease is significant, and survivors usually have permanent ocular and CNS impairment.
Marquez L, Levy ML, Munoz FM, Palazzi DL. A report of three cases and review of intrauterine herpes simplex virus infection. Pediatr Infect Dis J. 2011;30(2):153–157.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.