Topical Corticosteroids for Herpes Simplex Stromal Keratitis

The Herpetic Eye Disease Study (HEDS) was a randomized, double-masked, placebo-controlled, clinical trial to determine the efficacy of topical corticosteroids as adjunctive therapy in the treatment of herpes simplex stromal keratitis in patients who had not received any corticosteroids for at least 10 days before study enrollment. The study showed that topical corticosteroids can be used judiciously with protective antiviral cover in the acute treatment of patients with herpes simplex stromal keratitis who have not recently received corticosteroid therapy. Treatment reduced persistence or progression of stromal inflammation and shortened the duration of herpes simplex stromal keratitis. Postponing steroids during careful observation for a few weeks delayed resolution of stromal keratitis but did not worsen visual outcome at 6 months.