Herpes Simplex Keratitis

Herpes simplex type 1 may present as an active infection in the cornea (dendritic keratitis or stromal keratitis), active inflammation (disciform keratitis), or both.

Active infection is treated with antiviral medications (drops, gels, ointments, or pills) and active inflammation may be treated with steroid drops. Often the medications, especially steroids, are decreased slowly, typically over many months to years.

Herpes keratitis can recur. To decrease the risk of multiple recurrences, antiviral pills may be used for years.

Symptoms

Pain, redness, discharge, decreased vision. Often a history of previous episodes of ocular redness and inflammation.

Causes

Typically the herpes simplex type 1 virus. It is the same virus that causes cold sores in and around the mouth, where it can be annoying, but not generally a major problem. Unfortunately, the virus can also affect the cornea.

Risk Factors

Prior herpes simplex keratitis. Stress, sunlight exposure, and others factors may increase the risk of recurrences.

Complications

Corneal scarring, glaucoma, cataract, severe decreased vision or blindness.

Tests and Diagnosis

Slit lamp examination with special staining such as fluorescein dye is essential. Corneal viral cultures can be done, but are not commonly performed.

Treatment

Active infection is treated with antiviral medications (drops such as trifluridine, gel such as ganciclovir, ointment such as acyclovir or pills such as acyclovir, valacyclovir or famciclovir). Active inflammation, when severe enough, can be treated with steroid drops. Often the medications, especially steroids, are decreased slowly, typically over many months or years. Herpes keratitis (infectious or inflammatory) can recur. To decrease the risk of recurrence, antiviral pills may be used for years.