Seroprevalence and Clinical Insights of Ocular Herpesvirus Infections: A Cross-Sectional Study Evaluating ELISA as a Diagnostic Tool

Siyuan Chen,1,* Qi Peng,1,* Hailuo Wang,1 Jinglin Xie,1 He Cao,2 Xiaohong Xu1 1Department of Ophthalmology, Air Force Hospital of Eastern Theater Command, Nanjing, Jiangsu, 210002, People’s Republic of China; 2Department of Ophathalmology, Shenzhen People’s Hospital, Southern University of Science and Technology; The second Clinical Medical College, Jinan University, Shenzhen, 518020, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaohong Xu, Department of Ophthalmology, Air Force Hospital of Eastern Theatre Command, Nanjing, Jiangsu, 210002, People’s Republic of China, Email [email protected] He Cao, Department of Ophathalmology, Shenzhen People’s Hospital, Southern University of Science and Technology; The second Clinical Medical College, Jinan University, Shenzhen, 518020, People’s Republic of China, Email [email protected] and Objectives: Ocular infections caused by Herpes simplex virus (HSV) and Varicella-zoster virus (VZV) are major contributors to vision impairment worldwide, necessitating accurate and accessible diagnostic tools. This study aimed to investigate the seroprevalence of HSV and VZV infections in patients with suspected ocular infections and to evaluate associated risk factors.Methods: We conducted a cross-sectional study using enzyme-linked immunosorbent assay (ELISA) to detect antibodies against HSV and VZV in patients with ocular symptoms. Serological data were stratified into IgG and IgM positivity to differentiate past from active infections. Serological data were stratified into IgG (indicative of past infection) and IgM (suggestive of active infection) positivity to differentiate past from active infections. A total of 200 patients were enrolled, and demographic and clinical data were collected, including age, history of ocular surgery, and immunosuppressive therapy.Results: The overall seroprevalence for HSV was 14%, and for VZV, it was 9%. Age was a significant risk factor for both infections, with individuals over 50 years (mean age of 48.9 ± 13.8 years) showing increased seropositivity (p < 0.001). The predominant ocular manifestation for HSV was keratitis (69%), while VZV infections were most commonly associated with conjunctivitis (62%). We identified a strong association between ocular surgery and HSV/VZV seropositivity (p < 0.001), and immunosuppressive therapy was significantly linked with VZV seropositivity (p < 0.001).Conclusion and Recommendations: ELISA-based antibody detection proved effective in identifying both past and active HSV and VZV infections. The findings highlight age, ocular surgery, and immunosuppressive therapy as key risk factors for these infections. Given the diagnostic limitations of ELISA, future studies should incorporate molecular diagnostics for enhanced accuracy. These findings support the use of ELISA for screening high-risk populations, although adjunct molecular testing may improve diagnostic accuracy. Early serological screening in high-risk patients could aid in the timely detection and management of ocular herpesvirus infections.Keywords: herpes simplex virus, ocular herpesvirus, varicella-zoster virus, ELISA