We thank Hong et al for their interest in our recent study describing the characteristics of anterior segment herpes simplex in a large cohort of children.
1We are in complete agreement that data generated from randomized clinical trials are desirable. However, logistical issues and cost often preclude randomized trials for medications that are already approved for use. In the absence of level 1 evidence, large case series such as our study do provide a reasonable starting point to guide clinical care. We also agree that definitive diagnosis of herpes simplex can be made by polymerase chain reaction or viral culture. However, these tests are often not available and, when available, increase the costs of care and may result in a delay in initiating appropriate treatment while one is awaiting test results. Additionally, it can be challenging to collect samples from or perform cultures in children in the midst of active blepharoconjunctivitis. Even in the absence of laboratory testing, herpes simplex can usually be distinguished from entities such as adenoviral or zoster infection by careful history and clinical findings.
- Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes.Ophthalmology. 2012; 119: 2003-2008
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