HERPES SIMPLEX TREATMENT WITH IDU AND CORTICOSTEROIDS.

The use of corticosteroids in the treatment of infection by herpes simplex has been a subject of great controversy. Several articles have been written on the value of corticosteroids, especially in metaherpetic or disciform keratitis and in cases with herpetic iritis.1,2 On the other hand, even in patients with disciform disease and iritis, corticosteroids have been shown to cause recurrences of superficial corneal lesions and perforation of the cornea.3,4 Some authors have condemned their use, even in cases of disciform keratitis, while others, such as DeVoe, feel that the benefits of using corticosteroids in patients with stromal herpes or iritis are so great that such therapy is well worth the risk.5,6 The agent 5-iodo-2'-deoxyuridine (IDU) inhibits the synthesis of virus, and can successfully treat corneal disease caused by herpes simplex and vaccinia, without damaging normal tissues. It is not a cauterizing or debriding agent, but rather, as a thymidine antagonist, acts against viruses in a manner similar to that in which sulfa drugs act against bacteria.7 IDU alone, appears ef¬ fective in the treatment of dendritic ulcers with or without stromal involvement, geo¬ graphic ulcers which are part of an acute fulminating infection, and probably in the treatment of superficial stromal disease. It is not effective in the treatment of disciform keratitis with folds in Descemet's membrane, herpetic iritis, or bullous keratopathy asso¬ ciated with herpetic iritis.8 These latter con¬ ditions, which may well lead to blindness or dense permanent scarring have defied ade¬ quate therapy by any means. Corticosteroids may quiet the deeper inflammation, but the risk of such agents to the cornea has pre¬ vented their widespread use. Since the deleterious effects of corticosteroids occur primarily in the epithelium and stroma of the cornea, it seemed possible that IDU might serve to protect the cornea, while ther¬ apy with anti-inflammatory agents could benefit the deeper herpetic disease.