Herpes simplex keratitis

Herpetic Simplex Keratitis

A clinical image showing the characteristic dendritic ulcer of Herpetic Simplex Keratitis.

Herpetic simplex keratitis is an ocular disease caused by the herpes simplex virus (HSV) that affects the cornea, the clear front part of the eye. It is a recurrent condition that can lead to varying degrees of corneal damage.

Etiology and Pathophysiology

HSV is a widespread pathogen known to cause a variety of infections. In the context of herpetic simplex keratitis, the virus specifically targets the corneal epithelium. Following an initial or primary infection, the virus can enter a latent state within the nerves. Reactivation can occur due to various triggers, leading to recurrent episodes of the disease.

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The structure of HSV and its infection cycle.

Clinical Presentation

Initial Symptoms

The primary infection often manifests as blepharoconjunctivitis, characterized by swollen eyelids and conjunctiva, and may be accompanied by small, itchy lesions on the surface of the cornea.

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Eyelid swelling in a patient with herpetic simplex keratitis.

Corneal Manifestations

As the infection progresses, the surface of the eye can develop superficial punctate keratitis, where the corneal epithelium is dotted with minute lesions. In more severe cases, dendritic ulcers can form, which are distinctive in their branching pattern and are a hallmark of herpetic simplex keratitis.

A slit lamp photograph showing a dendritic ulcer characteristic of herpetic simplex keratitis.

Unilateral Presentation

Herpetic simplex keratitis usually affects only one eye at a time, though bilateral cases can occur, especially in individuals with compromised immune systems.

Symptoms

Patients with herpetic simplex keratitis may report a range of symptoms including:

• Deep dull pain within the eye
• Sensation of dryness and irritation
• Reduced visual acuity
• The feeling of having a foreign body in the eye
• Photophobia (light sensitivity)

Diagnosis

Diagnosis is primarily clinical but can be supplemented by laboratory tests such as viral culture, polymerase chain reaction (PCR), or serological tests to detect the presence of HSV.

Treatment

Treatment typically involves antiviral medication to reduce the severity and frequency of outbreaks. In cases where corneal scarring occurs, further interventions such as corneal transplant may be necessary.

Complications and Management

If left untreated, herpetic simplex keratitis can lead to complications like corneal scarring, thinning, and even perforation, which might necessitate corneal transplantation. Regular follow-ups and education on the importance of early treatment during recurrences are critical components of patient management.

Preventive Measures

Preventive strategies may include the use of antiviral prophylaxis, particularly in patients with frequent recurrences, and the management of known triggers such as ultraviolet light exposure.

See Also

• Cornea
• Virus
• Eye infection
• Conjunctivitis
• Corneal ulcer
• Dry eye syndrome
• Sinusitis
• Immunology
• Ophthalmology

External Links

• American Optometric Association
• American Academy of Ophthalmology

Herpes simplex keratitis Resources
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