Ocular Microbiology and Immunology Group
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2025 OMIG Abstract

Herpes vs OSSN: Infection vs Neoplasia

Despoina Theotoka, Wisam Najdawi, Wendy J. Li, Pragat J. Muthu, Sujin Kang, Anat Galor, Carol L. Karp

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida

Purpose: To evaluate whether a history of herpetic eye disease impacts the demographics, diagnostic features, management, and outcomes of ocular surface squamous neoplasia (OSSN).

Methods: A retrospective review was conducted comparing patients with OSSN and a history of herpetic disease to a historical control group of patients with OSSN alone. OSSN was defined by clinical exam, anterior segment OCT, or biopsy. Herpetic disease was defined by prior clinical history or signs of herpetic keratitis. Key outcomes included demographics, lesion characteristics, imaging findings, treatment response, and recurrence rates.

Results: The OSSN&Herpes group showed a trend toward more balanced gender distribution and greater racial diversity compared to the OSSN-only group. Lesion characteristics were broadly similar, though the OSSN&Herpes group had a higher rate of corneal involvement and a trend toward temporal location and opalescent appearance—none reaching statistical significance. On anterior segment OCT, classic OSSN features were present in only 26% of OSSN&Herpes cases, making diagnosis more challenging and prompting biopsy in 50% of cases. Subepithelial hyperreflectivity consistent with herpetic scarring was seen in 89% of cases. Treatment response to 5-FU was lower in the OSSN&Herpes group (66.7% vs 87%), with more treatment cycles required (mean 6.17 vs 4.93). There was a trend for higher recurrence at 2 years in the OSSN&Herpes group (46% vs 19%).

Conclusions: OSSN in patients with prior herpetic disease presents with atypical imaging characteristics, complicating diagnosis and management. These patients may require prolonged treatment, and closer surveillance due to higher recurrence rates. A high index of suspicion is warranted when evaluating surface lesions in patients with a history of herpetic disease.