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Herpes Simplex Keratitis Herpes simplex keratitis is a common form of infection affecting the cornea (the clear transparent dome-shaped window of the eye).
The dendritic ulcer causes photophobia, tearing, blurred vision, redness of the eye and pain.
The virus can also cause conjunctivitis with the presence of follicles in the conjunctiva, giving it a bumpy appearance. Steroid drops can exacerbate the dendritic ulcer and should only be used under supervision by an ophthalmologist. Steroid drops can result in the dendritic ulcer becoming much larger and affecting a wider area of the cornea – known as a geographic ulcer.
The virus lies dormant in the trigeminal nerve and can become reactivated during times of illness or stress or when you are feeling generally run-down.
Herpes simplex can affect other areas of the eye, causing trabeculitis (inflammation of the drainage area of the eye) leading to raised pressure within the eye and inflammation of the coloured part of the eye – uveitis.

Repeated recurrences usually lead to scarring and clouding of the cornea, a loss of sensation in the cornea and vessels growing across the cornea, sometimes causing lipid being deposited in the cornea (see picture below).
If this happens, sight is impaired and a corneal graft may become necessary to restore vision. Continue to use the site as normal if you're happy with this, or find out how to manage cookies. This infection is caused by the herpes simplex virus, the same virus which causes cold sores around the mouth. The dendritic ulcer can be diagnosed with the help of fluorescein eye drops which stain it a brilliant green colour which is then detected using the cobalt blue filter on the slit lamp.
However, with prompt treatment by a corneal specialist, these complications can be prevented or minimised. Herpes simplex can also cause swelling of the cornea known as a disciform keratitis where the cornea develops an immune reaction to the virus.

In a few extreme cases, it can also affect the back of the eye, causing an optic neuritis and inflammation of the retinal vessels causing acute retinal necrosis.Treatment of Herpes simplex infectionTreatment is usually successful with the application of an antiviral ointment or gel to the eye. How does it affect the eyeThe most common presentation of herpes simplex keratitis is the dendritic ulcer on the cornea which resembles a branching tree. In most cases, the ulcer heals with no sequelae but sometimes, faint scars remain on the cornea at the site of the previous ulcer. Several recurrences may result in the formation of deep ulcers, permanent scarring, and a loss of feeling when the eye is touched. The herpes simplex virus may also cause blood vessels to grow onto the cornea and this alone can lead to significant visual impairment.

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