Ocular viral infections.

The most important viral organisms involving the eye are the DNA viruses herpes simplex, varicella-zoster, cytomegalovirus, adenovirus, and vaccinia virus. All of these agents except CMV may cause acute epithelial infection, sterile trophic ulceration due to basement membrane damage, deep corneal stromal immune reaction, and iritis. Although there are three excellent antiviral drugs commercially available, only HSV and vaccinia virus are highly sensitive to therapy with these antimetabolites; varicella-zoster virus and CMV are equivocally responsive and adenovirus has not been shown to be susceptible to these agents. In selected situations, topical or systemic corticosteroids are useful for managing any associated immune reactions in the eyes, but patients on these drugs should be monitored carefully both for superinfections and for interference with tissue healing that might ultimately threaten the integrity of the globe.