Triggers for reactivation:
- Dormant virus particles can be reactivated by various triggers to either the ganglion or the cornea (mouth). These include stress, UV light (sun), trauma, fever, and menstruation.
- Excimer laser treatment and prostaglandin eye drops have also been linked to recurrence.
- Xalatan usage may cause pseudodendrites.
The original primary infection of trigeminal ganglion is more commonly associated with gingivostomatitis than ocular disease. Recurrence can then be either oral or ocular.
Timolol, epinephrine, and Latanoprost have all been linked over the years to reactivation. There are several theories--from decreased IOP causing retrograde axonal flow to corneal epithelial damage (trauma). In the case of epinephrine, the virus may actually be reactivated in the superior cervical ganglion.
Past herpetic infection needs to be considered when contemplating LASIK. The procedure can be performed with pre- and post-operative antiviral therapy.
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