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Herpetic simplex keratitis is a form of keratitis caused by recurrent herpes simplex virus in cornea. It has been estimated that one third of the world population suffers from recurrent infection. Recurrent herpes of the eye is caused by reactivation of the virus in a latently infected sensory ganglion, transport of the virus down the nerve axon to sensory nerve endings, and subsequent infection of ocular surface.
This classic herpetic lesion consists of a linear branching corneal ulcer (dendritic ulcer).
Patients with epithelial keratitis complain of foreign-body sensation, light sensitivity, redness and blurred vision. Focal or diffuse reduction in corneal sensation develops following recurrent epithelial keratitis. Localized endotheliis (localized inflammation of corneal endothelial layer) is the cause of disciform keratitis. A specific clinical diagnosis of HSV as the cause of dendritic keratitis can usually be made by ophthalmologists based on the presence of characteristic clinical features. Corneal smears or impression cytology specimens can be analyzed by culture, antigen detection, or fluorescent antibody testing.


Serologic tests may show a rising antibody titer during primary infection but are of no diagnostic assistance during recurrent episodes. Epithelial keratitis is treated with topical antivirals, which are very effective with low incidence of resistance. Topical corticosteroids are contraindicated in the presence of active herpetic epithelial keratitis; patients with this disease who are using systemic corticosteroids for other indications should be treated aggressively with systemic antiviral therapy.
Herpetic stromal keratitis is treated initially with prednisolone drops every 2 hours accompanied by a prophylactic antiviral drug: either topical antiviral or an oral agent such as acyclovir or valacyclovir. Treatment includes artificial tears and eye lubricants, stopping toxic medications, performing punctal occlusion, bandage contact lens and amniotic membrane transplant.
Keratitis caused by HSV is the most common cause of cornea-derived blindness in developed nations. Longstanding corneal edema leads to permanent scarring and is the major cause of decreased vision associated with HSV. Unilateral uveitis associated with high intraocular pressure is almost always caused by herpes. Diagnostic testing is seldom needed because of its classic clinical features and is not useful in stromal keratitis as there is usually no live virus.


Treatment of the disease with topical antivirals generally should be continued for 10– 14 days. The prednisolone drops are tapered every 1–2 weeks depending on the degree of clinical improvement. You may redistribute it, verbatim or modified, providing that you comply with the terms of the GFDL. Aciclovir ophthalmic ointment and Trifluridine eye drops have similar effectiveness but are more effective than Idoxuridine and Vidarabine eye drops.[4] Oral acyclovir is as effective as topical antivirals for treating epithelial keratitis, and it has the advantage of no eye surface toxicity. Topical antiviral medications are not absorbed by the cornea through an intact epithelium, but orally administered acyclovir penetrates an intact cornea and anterior chamber.




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