Ophthalmologists Urge Herpes Screening Before Eye Surgery
Ophthalmologists must prioritize identifying patients with a history of herpes simplex virus (HSV) before performing ocular surgeries to prevent viral reactivation. Common procedures, including corneal transplants, LASIK, and cataract surgery, serve as significant risk factors for the recurrence of HSV or zoster infections.
During the OSN New York and OSN New York Retina conference in early November 2026, medical experts emphasized that the high global prevalence of herpes makes preoperative screening essential. As Healio reported, the clinical challenge lies in the fact that approximately 90% of the global population carries HSV-1 or HSV-2, yet these latent infections often go unrecognized in surgical candidates.
Surgical Trauma and Steroids Can Trigger Dormant Viruses
The risk of a viral flare-up is not uniform across all eye surgeries. The mechanism involves surgical trauma or postoperative steroids—which can suppress local immunity—triggering the dormant virus to reactivate in ocular tissue. Jennifer M. Loh, MD, of Loh Ophthalmology Associates in Miami, noted that while cataract surgery is extremely common, it still presents a risk for patients who may unknowingly harbor the virus.
Clinical data suggests a hierarchy of risk based on the type of surgical intervention. Corneal transplants carry the highest association with recurrence, followed by lamellar keratoplasty. Refractive procedures such as PRK, LASIK, and SMILE also present risks, as does cataract surgery. If a reactivation occurs, patients may present with corneal scarring, neovascularization (the growth of new, abnormal blood vessels), or neurotrophic keratitis, a condition where the cornea loses its ability to heal due to nerve damage.
Prophylactic Strategies Vary in Absence of Universal Protocol
Because there is currently no universal consensus among ophthalmologists regarding a standardized treatment protocol, clinicians must rely on individualized preoperative assessments. Identifying “at-risk” patients involves looking for physical evidence of previous infections, such as existing corneal scars. Early identification allows for the implementation of prophylactic therapy to mitigate the chance of a postoperative outbreak.
Current practices in the United Kingdom, as noted in a study published in the Journal of Cataract and Refractive Surgery, demonstrate that preventive treatment is a common approach. A frequent therapeutic regimen involves the administration of valacyclovir at a dosage of 500 mg twice daily (BID) for one week prior to surgery, continuing through the end of the postoperative steroid treatment period.
Hierarchy of Surgical Risk and Common Preventive Approaches
| Procedure Type | Relative Risk Profile | Common Preventive Approach |
|---|---|---|
| Corneal Transplant | Highest Risk | Pre- and post-operative antiviral therapy |
| Lamellar Keratoplasty | High Risk | Pre- and post-operative antiviral therapy |
| Refractive (LASIK/SMILE/PRK) | Moderate Risk | Clinician-dependent prophylaxis |
| Cataract Surgery | Common Risk | Identification and monitoring |
The underlying goal of these interventions is to ensure better visual outcomes and higher patient satisfaction by avoiding the complications of viral keratitis (inflammation of the cornea). While the specific choice of medication and timing can vary between clinics, the emphasis remains on early detection and proactive management.
Patient Warning: Disclose Herpes History and Report Symptoms
Patients should not attempt to self-medicate with over-the-counter antiviral creams for ocular symptoms, as these are not intended for surgical recovery. If you are scheduled for eye surgery, you must disclose any history of herpes simplex or varicella-zoster (shingles). Immediately contact your ophthalmologist if you experience sudden eye pain, redness, blurred vision, or light sensitivity following a procedure, as these may be early indicators of a viral recurrence.
The focus for the ophthalmic community remains on refining these identification protocols to move toward a more standardized global approach to surgical safety.
