• Uveitis

    Review of: Distinguishing features of anterior uveitis caused by herpes simplex virus, varicella-zoster virus, and cytomegalovirus

    Terada Y, Kaburaki T, Takase H, et al. American Journal of Ophthalmology, July 2021

    This study compared the characteristics of the 3 types of herpetic anterior uveitis, each caused by a different herpesvirus.

    Study design

    This was a retrospective, multicenter case series from 11 tertiary centers in Japan. A total of 259 patients with herpetic anterior uveitis (AU) were evaluated, and distinguishing features were noted. Herpetic infection was diagnosed by either PCR-positive aqueous humor tests or presence of the classic signs of herpes zoster ophthalmicus.


    More similar features were found between patients with herpes simplex virus AU (HSV-AU) and varicella-zoster virus AU (VZV-AU) patients compared with patients with cytomegalovirus AU (CMV-AU). Unilateral uveitis and sudden onset with an acute clinical course were registered in patients with HSV-AU and VZV-AU, while patients with CMV-AU had bilateral AU, higher rates of insidious onset, and a chronic clinical course. Noted characteristics of HSV-AU and VZV-AU were ocular hyperemia and pain, medium-to-large keratic precipitates (KPs), blurring of vision, cells and flare in the anterior chamber, ciliary injection, and posterior synechia. Small KPs, coin-shaped KPs, diffuse iris atrophy, elevated IOP, and a history of glaucoma surgery were more frequently seen in CMV-AU.


    The retrospective study design can lead to a lack of information regarding the clinical manifestations of the disease. Due to eligibility criteria, patients with a chronic clinical course and recurrence, such as with CMV-AU, were enrolled to a much greater degree than patients with an acute clinical course. Also, this study may not reflect the general population; only patients from tertiary centers in Japan were included.

    Clinical significance

    Patients with HSV-AU and VZV-AU have predominantly unilateral involvement. Since HSV-AU and VZV-AU share similar clinical features, PCR aqueous humor tests may be helpful in distinguishing these clinical entities. Attention needs to be paid to IOP care in patients with herpetic uveitis due to the high risk of glaucoma development, especially in those with CMV-AU.