Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 4251
  • Home
  • Print this page
  • Email this page

   Table of Contents      
Year : 2006  |  Volume : 54  |  Issue : 1  |  Page : 47-48

Recurrence of bilateral herpes simplex virus keratitis following bimatoprost use

Glaucoma Service, Bombay City Eye Institute and Research Center, 5-Babulnath Road, Mumbai 400 - 007, Maharashtra, India

Correspondence Address:
Mihir Trilok Kothari
Jyotirmay Eye Clinic For Children and Squint, 205 Ganatra Industrial Estate, Pokhran Road 1, Khopat, Thane (West) 400 - 601, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.21617

Rights and Permissions

A 76-year-old man presented with features of bilateral herpes simplex virus (HSV) keratitis. It was found to be recurrence of bilateral HSV keratitis following the use of Bimatoprost eye drops for uncontrolled intraocular pressure in a case of bilateral primary open-angle glaucoma.

Keywords: Bimatoprost, herpes simplex virus keratitis, primary open-angle glaucoma

How to cite this article:
Kothari MT, Mehta BK, Asher NS, Kothari KJ. Recurrence of bilateral herpes simplex virus keratitis following bimatoprost use. Indian J Ophthalmol 2006;54:47-8

How to cite this URL:
Kothari MT, Mehta BK, Asher NS, Kothari KJ. Recurrence of bilateral herpes simplex virus keratitis following bimatoprost use. Indian J Ophthalmol [serial online] 2006 [cited 2021 Mar 2];54:47-8. Available from: https://www.ijo.in/text.asp?2006/54/1/47/21617

  Introduction Top

Bimatoprost is a synthetic ocular hypotensive agent structurally and pharmacologically similar to prostaglandin-F2-a1-ethanolamide, referred to as prostamide-F2- analog.[1] This agent is in the international market for use since March 2001. Since then, only one report has so far been published in the literature on the possible association between the use of this agent and the recurrence of herpes simplex virus (HSV) keratitis.[2] We herein report a case of bilateral herpes simplex keratitis reactivation following the use of 0.03% Bimatoprost ophthalmic solution (Lumigan, Allergan India Ltd., India).

  Case Report Top

A 76-year-old man with a 7-year-long history of bilateral primary open-angle glaucoma presented with complaints of pain, photophobia, and watering in both the eyes since 3 days. He was on twice-daily Optipress eye drops (0.5% betoxolol, Cipla Ltd., India) which was changed to a nightly dose of Lumigan (0.03% bimatoprost ophthalmic solution, Allergan India Ltd., India) 1 month ago. His past medical history was significant for an episode of herpes simplex keratitis in the right eye 4 years ago. The patient was wearing glasses since 40 years and had undergone combined cataract extraction and trabeculectomy in the left eye 5 years back. Systemic history was significant for noninsulin-dependant diabetes mellitus, essential hypertension, acute myocardial infarction, and coronary artery bypass grafting.

On examination, his best-corrected visual acuity in the right eye was 20/80, N12 and 20/20, N6 in the left eye. Intraocular pressure (IOP) in both the eyes was 14 mmHg and pachymetry was 560 m. Both the eyelids had mild swelling with severe blephrospasm and lacrimation, The cornea in the right eye showed dendritiform epitheliopathy with terminal bulb [Figure - 1] and similar but shorter pattern in the left eye [Figure - 2] that stained on fluorescin staining [Figure - 3].

The anterior chamber appeared quiet and there was an immature cataract in the right eye and pseudophakia with a scarred bleb in the left eye. Fundus examination showed a cup-disk ratio of 0.9 in both eyes. Both the optic disks measured 1.9 mm vertically with concentric thinning of the neuroretinal rim. Central 30 fields showed a double arcuate scotoma in both the eyes.

Lumigan was withdrawn from both the eyes. The patient recovered completely in 9 days with ocuvir eye ointment (3% acyclovir, FDC Ltd., India) and homide eye drops (2% homatropine, Warren Pharmaceuticals Pvt. Ltd, India). Since 1 year he has had no recurrence of keratitis and his IOP is controlled with alphagan (0.3% brimonidine, Allergan India Ltd., India).

  Discussion Top

Several investigators in the past have reported an association between the reactivation of HSV keratitis in the human eyes with the use of latanoprost, a prostaglandin-F2-a analog.[3],[4],[5] The final common pathway of the reactivation of HSV keratitis appears to be mediated by the prostaglandins. Recurrences and increased severity with the use of latanoprost in therapeutic dose are also reported in the rabbit models. [6],[7],[8]Akin to latanoprost, a possible association exists between bimatoprost and the recurrence of HSV.

Kroll and Schuman[2] have previously reported a case of HSV keratitis reactivation 1 month after starting the therapy in a patient 10 years after the first episode of the HSV keratitis. However, the time of reactivation is idiosyncratic and is reported to occur from few days to few months with latanoprost.[3] This may be related to factors involved with an individual's immunologic competence.

Confirmation of HSV with the diagnostic polymerase chain reaction or the isolation of the virus by culture could have been more helpful in both the cases. However, the presence of typical "terminal bulbs" with the dendritiform lesion rules out the possibility of pseudodendrites produced by the epithelial keratopathy (akin to medicamentosa).

Based entirely on a temporal association, we cannot suggest a cause-and-effect relationship between bimatoprost and the HSV keratitis recurrence. A rechallenge or controlled withdrawal (placebo control with only the vehicle) in one eye and continuing the medication in the other eye would probably provide better evidence. However, we were unable to perform this as it was judged to be not "in the best interest" of the patient.

The possibility exists that recurrence of HSV keratitis in our patient was purely coincidental. However, we believe this association to be real and reports as this one will promote awareness and further research on this subject.

  References Top

Krauss AH, Woodward DF. Update on the mechanism of action of bimatoprost: a review and discussion of new evidence. Surv Ophthalmol 2004;49:S5-S11.  Back to cited text no. 1
Kroll DM, Schuman JS. Reactivation of herpes simplex virus keratitis after initiating bimatoprost treatment for glaucoma. Am J Ophthalmol 2002;133:401-3.   Back to cited text no. 2
Wand M, Gilbert CM, Liesegang TJ. Latanoprost and herpes simplex keratitis. Am J Ophthalmol 1999;127:602-4.   Back to cited text no. 3
Dios Castro E, Maquet Dusart JA. Latanoprost-associated recurrent herpes simplex keratitis. Arch Soc Esp Oftalmol 2000;75:775-8.   Back to cited text no. 4
Ekatomatis P. Herpes simplex dendritic keratitis after treatment with latanoprost for primary open angle glaucoma. Br J Ophthalmol 2001;85:1008-9.   Back to cited text no. 5
Kaufman HE, Varnell ED, Toshida H, Kanai A, Thompson HW, Bazan NG. Effects of topical unoprostone and latanoprost on acute and recurrent herpetic keratitis in the rabbit. Am J Ophthalmol 2001;131:643-6.  Back to cited text no. 6
Camras CB. Latanoprost increases the severity and recurrence of herpetic keratitis in the rabbit; latanoprost and herpes simplex keratitis. Am J Ophthalmol 2000;129:271-2.   Back to cited text no. 7
Kaufman HE, Varnell ED, Thompson HW. Latanoprost increases the severity and recurrence of herpetic keratitis in the rabbit. Am J Ophthalmol 1999;127:531-6.  Back to cited text no. 8


  [Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 A Case of Herpetic Simplex Keratitis after Application of 0.015% Tafluprost Eye Drops
Ho Gyun Park,Sangkyung Choi
Journal of the Korean Ophthalmological Society. 2013; 54(12): 1950
[Pubmed] | [DOI]
2 Therapeutic uses of prostaglandin F2a analogues in ocular disease and novel synthetic strategies
Iwona Dams,Jaromir Wasyluk,Marek Prost,Andrzej Kutner
Prostaglandins & Other Lipid Mediators. 2013; 104-105: 109
[Pubmed] | [DOI]
3 Herpes Keratitis in a Patient Undergoing Treatment With Topical Mitomycin C :
Sana S Siddique, Luis Alonso Gonzalez-Gonzalez, Laura Amorese, Mehrine Shaikh, Stephen Foster
Cornea. 2011; 30(4): 466
[VIEW] | [DOI]
4 Effects of Common Topical Antiglaucoma Medications on the Ocular Surface, Eyelids and Periorbital Tissue :
J. Javier Servat, C. Robert Bernardino
Drugs & Aging. 2011; 28(4): 267
[VIEW] | [DOI]
5 Reactivation of Herpetic Keratitis in a Patient after Using Two Different Prostaglandin Analogues
Hyun Seung Yang, Ho Gyun Park, Sangkyung Choi
Journal of the Korean Ophthalmological Society. 2011; 52(9): 1119
[VIEW] | [DOI]
6 Bimatoprost a review
Patil, A.J., Vajaranant, T.S., Edward, D.P.
Expert Opinion on Pharmacotherapy. 2009; 10(16): 2759-2768
7 Herpetic keratitis and keratouveitis after mitomycin-C use in glaucoma filtering surgery: A short case series
Rao, A., Tandon, R., Sharma, N., Sihota, R., Gupta, V., Dada, T.
European Journal of Ophthalmology. 2009; 19(6): 1088-1090
8 Herpetic keratitis in a patient who used two different prostaglandin analogue ophthalmic solutions: A case report
Villegas, V.M., Daz, L., Izquierdo, N.J.
Puerto Rico Health Sciences Journal. 2008; 27(4): 348-349
9 Herpetic Keratitis in a PatientWho UsedTwo Different Prostaglandin Analogue Ophthalmic Solutions: a Case Report
VIllegaS, V.R.M. and lIllIaM Diaz, BS and IzquIeRDo, N.I.J.
Microqueratomo o laser de femtosegundo Videooculografia 3D La actualizacion en Oftalmologia Queratitis herpetica. ; : 77


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Case Report
Article Figures

 Article Access Statistics
    PDF Downloaded306    
    Comments [Add]    
    Cited by others 9    

Recommend this journal