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Pronunciations acyclovir conjunctivitis corticosteroid keratitis keratoconus keratomalacia keratopathy trifluridine

Herpes simplex keratitis is infection of the cornea caused by herpes simplex virus.

The herpes simples virus (which causes cold sores) never leaves the body after an initial infection (primary infection). Instead, the virus remains in a dormant stage in the nerves. Sometimes, the virus reactivates and causes further symptoms.

Primary herpes simplex eye infections usually occur in children and cause a mild keratoconjunctivitis (see Viral Infections: Herpes Simplex Virus Infections). Symptoms usually resemble those of common conjunctivitis, so the diagnosis of herpes simplex infection is not made. The infection resolves on its own. However, if the infection reactivates, it can affect the cornea more seriously and cause more severe symptoms.

Symptoms of a reactivation include eye pain, tearing, redness, and sensitivity to bright light. Rarely, the infection worsens and the cornea swells, making vision hazy. The more often the infection recurs, the more likely is further damage to the surface of the cornea. 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 can also cause blood vessels to grow onto the cornea and, occasionally, can lead to significant visual impairment. To diagnose a herpes simplex infection, a doctor examines the eye with a slit lamp (see What Is a Slit Lamp?). Sometimes, the doctor may take a sample from the infected area to identify the virus (viral culture).

The doctor may prescribe an antiviral eye drop, such as trifluridine Some Trade Names
VIROPTIC
. Acyclovir Some Trade Names
ZOVIRAX
, another antiviral drug, can be taken by mouth. Treatment should be started as soon as possible. Deep infections that cause a lot of inflammation may require use of corticosteroid drops and drops that dilate the eye, such as atropine Some Trade Names
ATROPEN
or scopolamine Some Trade Names
TRANSDERM SCOP
. Occasionally, to help speed healing, after numbing the eye, an ophthalmologist may have to gently swab the cornea with a soft cotton-tipped applicator to remove infected and damaged cells.

Last full review/revision October 2008 by Melvin I. Roat, MD