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Association of Anti–Herpes Simplex Virus IgG in Tears and Serum With Clinical Presentation in Patients With Presumed Herpetic Simplex Keratitis

Borderie, Vincent M. MD, PhD*; Gineys, Raquel MD*; Goldschmidt, Pablo MD*,†; Batellier, Laurence MD; Laroche, Laurent MD*; Chaumeil, Christine MD*,†

doi: 10.1097/ICO.0b013e31823f771f
Clinical Science

Purpose: To assess the clinical relevance of tear anti-herpes simplex virus (HSV) antibody measurement for the diagnosis of herpes simplex keratitis.

Methods: Records of 364 patients clinically suspect of HSV-related keratitis who had tear anti-HSV IgG assessment (tear-quantified anti-HSV IgG/filtrated IgG ratio) in our institution between January 2000 and August 2008 were retrospectively analyzed. Patients were classified into 4 groups as follows: group 1, anti-HSV IgG negative in serum and tears; group 2, anti-HSV IgG negative in tears and positive in serum; group 3, anti-HSV IgG nonsignificantly positive in tears and positive in serum; and group 4, anti-HSV IgG significantly positive in serum and tears. Randomly selected patient charts from each group were reviewed for clinical data.

Results: The prevalence of anti-HSV IgG in blood increased with age from >70% before 20 years to 95% after 70 years. The prevalence of anti-HSV IgG in tears increased with age from 20% before 20 years to >50% after 70 years. The presence (either significant or not) of anti-HSV IgG in tears was significantly associated with decreased corneal sensation, presence of stromal opacities, and with neurotrophic keratitis. Logistic regression showed no significant association between age and clinical signs except for herpetic ulcers and herpetic necrotizing keratitis.

Conclusions: Tear production of anti-HSV IgG increases with age, and it is associated with sequelae of herpes simplex keratitis. Conversely, it is poorly associated with clinical signs of acute herpes simplex keratitis.

*Federation of Ocular Infectious Diseases

Laboratory of Microbiology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris cedex 12, France.

Reprints: Vincent M. Borderie, Centre Hospitalier National d'Ophtalmologie des XV-XX, 28 rue de Charenton, 75571 Paris, France (e-mail:

Supported by the Pierre and Marie Curie University, Paris, France.

The authors state that they have no proprietary interest in the products named in this article.

Received May 24, 2011

Accepted October 25, 2011

© 2012 Lippincott Williams & Wilkins, Inc.