- 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.
- 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