HSV Keratitis


  • HSV keratitis (HSK) is the most common infectious cause of unilateral blindness in the developed world.
  • In the United States alone, there are approximately 20,000 new cases per year.


  • Ocular herpetic disease is more frequently caused by HSV I, which is presumed to gain access to the cornea via direct contact or via the trigeminal nerve from oral infection.

Clinical Manifestations

  • Typically, patients with HSV keratitis present with blurry vision, extreme photophobia, pain, redness, and tearing.
  • Primary ocular HSV presents as periocular and eyelid vesicles, acute follicular conjunctivitis, and in some cases with keratoconjunctivitis.
  • Latent in the trigeminal ganglion; can reactivate anytime, particularly by stress, UV radiation, a compromised immune system, and hormonal changes
  • Recurrent HSK can ultimately lead to corneal scarring, ocular surface disease, neurotrophic keratopathy, and consequently to corneal perforation and blindness in severe cases


  • Clinical dx: special attention should be paid to the presence of a preauricular lymph node, vesicular lesions on the lids or adnexa, bulbar follicles, decreased corneal sensation, and most notably the presence of epithelial dendrites on the cornea.
  • Corneal scrapings of HSV keratitis prepared with Giemsa stain may reveal the presence of intranuclear viral inclusion bodies.


  • Primary HSV epithelial keratitis usually resolves spontaneously, however, treatment with antiviral medication does indeed shorten the course of the disease and may therefore reduce the long term complications of HSV.
  • Antiviral treatment: either topical therapy with trifluridine 1% eight to nine times a day or oral administration of acyclovir or valacyclovir for 10 to 14 days.


  • Corneal complications: may develop ulceration
  • Visually significant corneal scarring and irregular astigmatism.

Ophthalmology and Eye Diseases 2012:4 23–34