Herpetic Keratitis: Causes, Symptoms, and Treatment

• Type I most commonly and almost exclusively affects the face, causing what most people call a “cold sore” or “fever blister.”
• Type II is the sexually transmitted form of the virus that typically infects the genitals.

While both forms of herpes can spread to the eye, Type I is most common and is the most frequent cause of eye infection. The infection can be transferred by touching an active lesion (a cold sore or blister) and then rubbing or touching your eye.

In many cases, once the original infection subsides, the virus remains dormant in the body, living in nerve cells located in the eye or skin, without issue. However, certain things can reactivate or trigger a subsequent infection. Some of the most common triggers include:

• Stress;
• Exposure to sun;
• Fever;
• Trauma to the body, including injury or surgery;
• Menstruation;
• Certain medications.

Symptoms of Herpetic Keratitis

As you might imagine, herpetic keratitis can be very painful. This is because the condition typically affects the nerves located in and around the eye directly. If you have the condition, you may experience some or all of these common symptoms:

• Pain in or around just one eye;
• Headache and fever;
• Redness, rash, or sores on the eyelids or around the eyes, particularly on the forehead (The rash may also erupt on the tip of the nose.);
• Redness in or around the eye;
• Blurred vision;
• Swelling and cloudiness of the cornea;
• Feeling of dirt or “grit” in the eyes;
• Overflowing tears;
• Pain or sensitivity when looking at bright lights.

In addition to these common symptoms, some individuals may experience different signs of the condition depending on what type or stage of infection he or she is experiencing.

Primary Infection

If the infection is a primary or initial infection, it often presents as nonspecific self-limiting conjunctivitis. This often occurs in early childhood and does not impact the cornea. In more advanced cases, symptoms may involve the feeling of grit in the eye, sensitivity to light, and others. Additionally, some individuals may develop blisters on the eyelid, blurred vision, or other issues.

Recurrent Infection

If the infection is recurring, it may involve more progressive complications. These issues my include tearing, sensation of foreign substances in the eye, and a branching lesion in the cornea. Multiple recurrences of the condition may cause permanent scarring and reduced vision.

Stromal Involvement

In some cases, the stroma becomes involved. If that is the case, necrosis of the stroma as well as severe pain, sensitivity to light, and reduced vision are common.

Causes of Herpetic Keratitis

Herpetic keratitis is caused by the herpes simplex virus; however, several different factors play into an actually eruption of the infection itself. For example, onset of the condition may be caused by:

• Injury – If an object scratches the surface of the cornea, it may be more susceptible to infection with the herpes virus.
• Contaminated contact lenses – Likewise, a contaminated lens is another common factor that can play a role in infection. If you touch your mouth or other skin that is currently infected or inflamed with herpes, and then touch your contact lens or eye, you can contract the infection.
• Viruses – Direct exposure to the virus itself can also cause infection or an eruption of the condition.

Because the condition must initially be spread following contamination with the virus itself, it’s important to practice effective eye hygiene, including washing your hands after performing any bodily function and before inserting or removing your contact lenses. Likewise, keeping your contacts and other eyewear in a safe, clean place is also important to best avoid infection.

Herpetic Keratitis Treatment

Most outbreaks of herpetic keratitis will resolve themselves spontaneously within 3 weeks of infection, most treatment options involve minimizing damage to the eye and preventing scarring. Topical and oral therapy are most common, but some other forms of treatment may also be necessary depending on the extent of the infection.

Topical Therapy

One of the most common forms of treatment is the topical ganciclovir ophthalmic gel. This option is minimally damaging to the cornea, requires less frequent applications, and has a convenient gel formulation. Trifluridine solution and vidarabine ointment are also common topical treatments. In most cases, topical treatments see results in 2-5 days with complete resolution of the issue in 2 weeks.

Oral Therapy

Some doctors rely on oral therapy to treat this common infection. Oral acyclovir has been found as effective as topical antivirals for remedying the condition. It is also an advantageous option compared to topical methods, as it incurs no ocular toxicity. This treatment option is preferred specifically for patients with preexisting conditions as well as those who are immunocompromised and for pediatric patients.

Your doctor will work with you to determine the most effective form of treatment for you.

Final Thoughts

Herpetic keratitis is a relatively common and very treatable condition. The disease is caused by the common herpes virus and may infect the eyelid and surrounding areas. One major concern if left untreated is diminished vision. Most individuals respond well to topical or oral treatment and experience full recovery within 2-3 weeks of diagnosis. It is important, however, to seek doctor care for this condition to avoid any pervasive long-term issues.