Author reply

      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.
      • Liu S.
      • Pavan-Langston D.
      • Colby K.A.
      Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes.
      We 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.

      Reference

        • Liu S.
        • Pavan-Langston D.
        • Colby K.A.
        Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes.
        Ophthalmology. 2012; 119: 2003-2008

      Linked Article

      • Oral Acyclovir for Herpes Simplex Blepharoconjunctivitis in Children
        OphthalmologyVol. 120Issue 6
        • In Brief
          We read the article by Liu et al1 on the clinical characteristics, treatment, and outcomes of pediatric herpes simplex virus (HSV) infections of the anterior segment with great interest. The researchers found that of the 53 patients (57 eyes), 18 eyes had HSV blepharoconjunctivitis (HBC) only. Eighty percent of patients had recurrent disease. Thirty-six percent of patients receiving long-term oral acyclovir had recurrent HSV. The authors suggested that physicians caring for children with recurrent unilateral blepharoconjunctivitis, keratitis, or both should consider the diagnosis of HSV infection and treat patients with oral acyclovir.
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