It can be difficult to identify viral infection from clinical signs alone, Dr. Chee said, and virtually impossible to identify the specific pathogen without an anterior chamber tap and testing. CMV, for example, can present in the anterior chamber as acute relapsing hypertensive anterior uveitis, also known as Posner-Schlossman syndrome (PSS), as Fuchs heterochromic iridocyclitis (FHI) or corneal endotheliitis as well as sector iris atrophy with iritis. Eyes with CMV-associated anterior uveitis do not show corneal scars, posterior synechiae, flare or fibrin and there is no clinically evident posterior segment involvement. Rubella and other viral infections can present with very similar features.
“The predominant types of viral infection varies from country to country, but reports in the literature suggest that herpes virus infection is common worldwide,” Dr. Chee said. “If the patient presents with ocular hypertension or has iris atrophy, they should be tested for viral infection to ensure appropriate treatment.”
For patients with rubella infection, ignore the infection and treat the cataract and glaucoma.
For patients with CMV infection, about two-thirds respond to ganciclovir gel 0.15 percent. Higher doses may be needed in patients who do not respond.
If topical therapy fails, she recommended oral valganciclovir 900 mg twice daily until PCR is negative, followed by 900 mg each morning. Expect to use oral valganciclovir for at least two to three months and the topical formulation for at least 6 months to reduce the risk of recurrence. Topical nonsteroidal anti-inflammatories or corticosteroids are useful to treat inflammation.