Herpetic keratitis

Herpetic keratitis

In this article, we will tell you:

95% of the world’s population has herpes. For some, it manifests itself on the lips, for someone on the oral mucosa (stomatitis), but few people know that the herpes simplex virus (HSV) can affect the eyes too.

There are as many as six types of this virus, so even if you have one of them, you are not immune from infection by other types. Let’s see how many there are and who is who:

  • Herpes simplex virus type I is a familiar culprit for the appearance of blisters on the lips;
  • HSV type II causes genital herpes;
  • Chicken pox (chickenpox), or herpes zoster;
  • Epstein-Barr virus – infectious mononucleosis;
  • Cytomegalovirus;
  • Herpes virus type VI (HHV-6).

It is known that it is completely impossible to cure herpes, it will still circulate throughout the body, even if it does not make itself felt. Doctors warn that not treating herpes is dangerous. This is fraught with complications: it can also cause eye infections, which can cause scars and injuries. One of the manifestations is herpetic keratitis.

What it is?

Herpetic keratitis is a disease that develops due to exacerbation of HSV or direct damage to the cornea of the eye. Most often this problem overtakes young children, but it is also observed in adults.

Signs and symptoms of herpetic keratitis

Herpetic keratitis tends to develop gradually and may be subtle at first and usually only affects one eye.

Over time, the patient begins to worry about excessive tearing and redness – all this resembles signs of bacterial inflammation. You may also see:

  • Frequent blinking;
  • Lachrymation ;
  • Increased photosensitivity;
  • Redness (hyperemia), irritation, stinging, and foreign body sensation in the eye
  • Increased body temperature, fatigue and drowsiness.

Simple hypothermia, excessive exposure to ultraviolet rays, severe stress, trauma or pregnancy can provoke an exacerbation and lead to keratitis. If the immune system copes with herpes and is able to suppress it, the disease will pass quickly enough. In cases where the body is no longer able to fight a high concentration of the virus in the blood, frequent relapses occur, the infection penetrates into the deep layers of tissues. The skin around the eyes may be covered with small bubbles. In severe cases, conjunctivitis, keratitis (inflammation of the cornea), and an increase in parotid lymph nodes can join the listed symptoms.

If you notice manifestations of this pathology in yourself, first of all:

  • Stop wearing contact lenses;
  • Don’t touch your eyes;
  • Do not use steroidal anti-inflammatory eye drops;
  • Seek help from an optometrist or therapist as soon as possible.

Depending on the mechanism of development, the following types of the disease are distinguished. Herpetic keratitis are:

  • Primary. Usually develop in children due to a weak immune system, affect the entire body as a whole, and not just the eyes;
  • primary – this is a complication of the transferred chickenpox or against the background of a decrease in immunity, in which there are no skin rashes, but lacrimation , photophobia, involuntary closing of the eyelids (corneal syndrome) are pronounced ;
  • Secondary, that is, recurrent.

Ophthalmologists also distinguish between the following forms of herpetic keratitis:

  • Tree-like (epithelial keratitis). It affects the upper layers of the cornea, bubbles form on it, leaving behind gray furrows, which, when stained , look like tree branches. Flies, lightning and spots may appear in the field of view. Tree-like keratitis is characterized by severe pain, lacrimation and prolonged course, provokes damage and exfoliation;
  • Discoid ( stromal keratitis). It proceeds slowly, it does not appear as sharply as the previous form. An infected fluid forms in the cornea, the central part of the membrane is damaged, and edema occurs. When the edema thickens, clear gray-white foci (clouding of the cornea) form, which interfere with the refraction of light and impair vision;
  • diffuse. By all indications, it resembles a discoid variant, but the corneal lesion does not have outlined contours.
  • Metaherpetic (deep). Due to untreated dendritic keratitis, a deeper variant of the lesion develops.
  • Keratoiridocyclitis . Not only the cornea becomes inflamed, but also the iris of the eye, its color changes, the vessels are affected, purulent discharge, and an increase in intraocular pressure are possible. The patient is concerned about tingling and paroxysmal pain in the eyes, forehead and temples – this indicates irritation of the trigeminal nerve.

The consequence of any type of eye herpes, in which the inflammatory process goes deep, can be a corneal ulcer, followed by necrosis and melting of the corneal tissues.

Diagnosis and treatment of herpetic eye disease

Herpetic keratitis requires a comprehensive examination. An ophthalmologist for the selection of treatment tactics needs to determine the localization of the focus of inflammation and the stage of the disease.

The specialist will:

  • External examination and viziometry – checking visual acuity according to the table;
  • Biomicroscopy – a detailed study of the conjunctiva, cornea, iris, anterior chamber of the eye, lens and vitreous body.

In addition to visual inspection for diagnosis, you may need to take tests:

  • Blood, tissue samples (scraping from the conjunctiva) for markers of herpes infection;
  • Check the lacrimal fluid for the presence of antiherpetic antibodies;
  • PCR;
  • enzyme immunoassay.

As a rule, therapy for keratitis includes the use of topical and general antiviral drugs (eye drops, ointments, tablets). Immunity enhancing agents are also used, which contain analogues of interferon – a protein that blocks the reproduction of the virus in the cells of the body – or substances that stimulate its natural production.

Keratitis in the early stages responds well to treatment. In cases where the inflammatory process does not stop within a few weeks, and medications (conservative treatment) do not help, surgical intervention is required. Surgical treatment may include:

  • Scraping of damaged layers of the cornea and antiseptic treatment;
  • Layered or penetrating keratoplasty – removal of the affected membrane and transplantation of the donor cornea.

The treatment of herpetic keratitis, as well as other eye pathologies, should be handled by an ophthalmologist. It is impossible to get rid of such a pathology by folk methods (lotions, heating) or self-medication at home. Self-medication significantly increases the risk of vision loss and complications.


In order to prevent and reduce the risk of developing herpetic keratitis, it is recommended to give preference to disposable contact lenses or carefully care for reusable ones. Remember to remove your lenses at night, rinse them with a solution, change them regularly, and of course, wash your hands as often as possible. Also, in no case do not touch herpes on the lips or nearby areas and use only those medicines that your doctor has prescribed.

Try to minimize the risk of injury to the eyes, because this can provoke a relapse or allow the virus to penetrate into the tissues. For this:

  • Always wear protective goggles if your work involves construction, welding and repair;
  • Follow the rules indicated on the packaging of cleaning products to exclude the possibility of corneal burns;
  • Try not to overheat, do not get cold, wear personal protective equipment in public places (medical masks or respirators, screens and goggles).

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