Keratitis, Herpetic Kerato conjunctivitis (Ocular Herpes or Eye Herpes)

Herpetic Keratitis, commonly known as Eye Herpes is an inflammation of the cornea, the clear dome that covers the front part of the eye. Herpetic Keratitis is caused by the Herpes Simplex viruses.

Overview, Causes, & Risk Factors Nearly everyone is exposed to the virus during childhood.  Herpes simplex is transmitted through bodily fluids, and children are often infected by the saliva of an adult.  The initial infection is usually mild, causing only a sore throat or mouth.  After exposure, herpes simplex usually lies dormant in the nerve that supplies the eye and skin.

When the eye is involved, herpes simplex typically affects the eyelids, conjunctiva, and cornea.  Keratitis (swelling caused by the infection), a problem affecting the cornea, is often the first ocular sign of the disease.  In some cases, the infection extends to the middle layers of the cornea, increasing the possibility of permanent scarring.  Some patients develop uveitis, an inflammatory condition that affects other eye tissues.

Signs and Symptoms

Pain, redness of the eye, excess tears, light sensitivity, irritation, itchiness, and decreased vision are usually the symptoms of eye herpes.

Herpes simplex virus (HSV) infections involving the lid may present in one of two forms. The classic appearance involves an accumulation of small vesicles or pustules along the lid margin and/or periocular skin. These lesions typically have an inflamed, erythematous base. Within the first week of infection, the vesicles may ulcerate or harden into crusts. A second “erosive-ulcerative” form of HSV blepharitis has also been described. This presentation is characterized by erosions of the lid at the Gray line or ulcers along the lid margin, or a combination of both. The lid typically displays generalized swelling and redness associated with these lesions.

HSV blepharitis is encountered primarily in children, although adults may also manifest this disorder. Presenting symptoms include pain and tenderness upon palpation, as well as increased lachrymation in severe cases. If the conjunctiva is involved, tarsal follicles may be observed along with bulbar injection and chemosis. Swollen pre-auricular nodes (pre-auricular lymphadenopathy) on the involved side is common.

Primary ocular infections occur most often in children between the ages of 6 months and 5 years, and almost invariably present as blepharitis or blepharoconjunctivitis. In recurrent attacks, the virus usually reappears as a dendritic keratitis. Several reports of recurrent HSV blepharitis have been reported in the literature, however.

Detection and Diagnosis

Herpes simplex is diagnosed by slit lamp examination. Tinted eye drops that highlight the affected areas of the cornea may be instilled to help the doctor evaluate the extent of the infection.  

Treatment

Treatment of herpes simplex keratitis depends on the severity.  An initial outbreak is typically treated with topical and sometimes oral anti-viral medication. The doctor may gently scrape the affected area of the cornea to remove the diseased cells.  Patients who experience permanent corneal scarring as a result of severe and recurrent infections may require a corneal transplant to restore their vision.

There is no specific treatment for HSV blepharitis, and most often the course of the disease is self-limiting. The use of warm saline compresses with a topical drying agent (e.g. 70% alcohol) is usually sufficient to palliate the patient. If the lesions are extensive, concomitant use of a topical antibiotic ointment is prudent to prevent a secondary opportunistic bacterial infection. The use of topical or oral antiviral agents has not been proven to enhance the recovery of patients with HSV blepharitis, although it is advocated by some practitioners for more severe cases. The use of topical steroids on HSV lid lesions may be unwise, particularly if there is other ocular involvement. Although corticosteroids may be used without fear in cases of herpes zoster (HZO) blepharitis, their use in cases of HSV infection may predispose the patient to the eruption of a dendritic keratitis.

Additional Clinical Information

Always include HZO in the differential diagnosis of HSV blepharitis. Keep in mind, however, that HZO typically affects elderly patients over the age of 70. Younger patients who present with HZO are often immunocompromised secondary to disorders such as AIDS or lymphoma. HSV blepharitis is usually encountered in children, but can occur at any age.

Although herpes simplex is known as a sexually transmitted disease, the vast majority of ocular herpes infections are not contracted via sexual contact. This is very important to recognize when considering pediatric cases of HSV blepharitis.

  • What is Eye Herpes?
  • Should you see a Doctor for Eye Herpes?
  • Is Eye herpes Contagious?
  • How common is Eye Herpes?
  • What Causes Eye Herpes?
  • What are the symptoms of Eye Herpes?
Symptoms caused by HSV 1 infection (HSV 1 is known to affect the following areas of the body.)

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Types of Human Herpes Virus
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