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Herpex Simplex Keratitis reactivation following the use of prostaglandin analogue ophthalmic solution

Poster Details

First Author: C.Kanonidou GREECE

Co Author(s):    E. Kanonidou   I. Zampros   V. Konidaris   T. Lalias   G. Sakkias  

Abstract Details


Glaucoma is one of the leading causes of preventable blindness and prostaglandin analogues have been used widely in its therapy. There have been few case reports in the literature suggesting the potential association between the topical use of prostaglandin analogues and herpes simplex virus (HSV) recurrence causing keratitis. We present a case of HSV keratitis reactivation following the instillation of tafluprost for glaucoma management, and the lessons learnt.


Department of Ophthalmology, ‘’Hippokrateion’’ General Hospital of Thessaloniki, Thessaloniki, Greece.


A 65 year old female patient attended the outpatient glaucoma clinic of our hospital complaining of blurred vision, pain, redness, tearing, photophobia and foreign body sensation in her right eye. She had been under the care of the same clinic after being diagnosed with ocular hypertension and increased risk for glaucoma. She had been treated with prostaglandin analogue (first line treatment) for a week before the development of the above mentioned symptoms. The patient’s past medical history was insignificant for immune system disorders, other infections, receipt of immunosuppressant medications or corticosteroids.


The slit lamp examination revealed a linear-branching dendritic ulcer with characteristic terminal buds, located centrally, stained well with fluorescein, accompanied by reduced corneal sensation, which is pathognomonic of HSV corneal infection. Prostaglandin analogue was discontinued and treatment with antiherpetic agents (acyclovir ophthalmic ointment 3% applied five times daily) and lubricants was initiated. After 2 weeks of therapy, the dendritic ulcer was resolved and the patient’s vision was restored to pre-event levels in 2 months’ time.


It has been reported that the final pathway of HSV reactivation appears to be mediated by prostaglandins. Therefore, prostaglandin analogues should be prescribed with caution in patients with previous herpetic infections and especially those with history of HSV keratitis. Case reports like this can promote awareness between health care professionals for the unusual side-effects of commonly used medications.

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