Therapeutic considerations in herpes-associated secondary glaucoma – clinical cases

Herpetic uveitis, most commonly caused by herpes simplex virus (HSV) and varicella-zoster virus (VZV), is a frequent cause of secondary glaucoma. Elevated intraocular pressure (IOP) in these patients is primarily due to inflammatory trabeculitis, trabecular meshwork obstruction, and steroid-induced mechanisms. IOP control is often challenging, and some cases require surgical intervention. Two patients without prior glaucoma developed refractory IOP elevation following herpetic uveitis. Clinical evaluation included tonometry, biomicroscopy, and monitoring of responses to medical and surgical therapy. Both patients received systemic antiviral therapy with valacyclovir. Medical antiglaucoma treatment alone failed to achieve adequate IOP control. In the first patient, glaucoma developed after active herpetic uveitis; in the second, after cataract surgery in an eye with a history of herpetic infection. Following preoperative antiviral preparation, trabeculectomy was performed, resulting in stable postoperative IOP. Herpetic secondary glaucoma can present with refractory IOP even in patients without prior glaucoma, and timely antiviral therapy and surgical management are essential for long-term control.