Herpes simplex keratitis is an infection of the cornea caused by the herpes simplex virus (HSV). Also known as eye herpes, this illness should be treated by a physician as complications can arise.
Patients with HSV keratitis may develop the following:
A history of prior episodes will appear in patients with recurrent disease.
The diagnosis of herpes simplex infection is often overlooked because symptoms usually resemble those of common conjunctivitis. Ocular pain is usually not a symptom of common conjunctivitis. The infection may resolve on its own or, especially if the infection reactivates, it can affect the cornea more extensively, and symptoms may be more severe.
Symptoms and signs of reactivation include eye pain, blurred vision, tearing, redness, and sensitivity to bright light. Rarely, the infection worsens and the cornea swells, making vision even hazier. The more frequently the infection recurs, the more likely there is to be further damage to the cornea. Several recurrences may result in the formation of deep ulcers, permanent scarring, and a loss of feeling when the eye is touched. The herpes simplex virus may also cause blood vessels to grow into the cornea, and this alone can lead to significant visual impairment.
If you have eye pain associated with loss of vision, loss of eye movement, painful eye movement, eye swelling, eye discharge, or severe headache, seek advice from your doctor or an ophthalmologist. It is difficult over the phone for a doctor or a nurse to grade the severity of eye pain and make a diagnosis without examining you. All of the above symptoms are significant findings that need to be evaluated by your primary physician or ophthalmologist immediately.
Because of the specialized nature of eye examination equipment, most eye problems are usually handled best in your ophthalmologist's office. If an ophthalmologist is not available, go to a hospital's emergency department. If the emergency department has the necessary eye equipment, an ophthalmologist may see you in the emergency department after hours.
Medical evaluation of patients with eye pain or other symptoms begins with a thorough history and physical examination. The history consists of questions documenting the symptoms in detail.
Seek medical attention if you have eye pain.
The doctor may prescribe an antiviral eyedrop or gel such as trifluridine (Viroptic) or ganciclovir (Zirgan). Acyclovir (Zovirax), another antiviral drug, can be taken by mouth. Treatment should be started as soon as possible. Infections that cause deep inflammation may require the use of corticosteroid drops and drops that dilate the eye, such as atropine (Atreza) or scopolamine (Scopace). Occasionally, to help speed healing, an ophthalmologist may gently rub the surface of the cornea to remove the infectious viruses and viral antigens that contribute to the keratitis. Since most cases of HSV epithelial keratitis resolve spontaneously within three weeks, the rationale for treatment is to minimize damage and scarring. Antiviral therapy, topical or oral, is an effective treatment of ophthalmic herpes infections. Patients with frequent recurrences of ocular HSV may be placed on a long-term regimen of oral antiviral medication at a maintenance dose to reduce this frequency.
Follow-up care usually depends on the severity of the eye problem. Signs and symptoms of recurrence of herpes simplex keratitis are similar to the first episode. Return to your ophthalmologist or the emergency room if you have increased eye pain, any loss of vision, increased eye discharge or redness, or swelling around the eye. Patients with HSV keratitis need to be monitored closely until the disease is inactive. Any suspicious corneal cloudy area (infiltrate) in the presence of HSV epithelial keratitis should be cultured for possible secondary bacterial, fungal, or parasitic infection and then managed with appropriate topical agents.
Contact lens wear, although not contraindicated in patients with previous HSV keratitis, should be used with caution. Patients should understand that contact lens wear may increase the risk of secondary corneal infection with HSV epithelial keratitis. They should be instructed to discontinue contact lens wear at the earliest symptoms of HSV keratitis recurrence.
Herpes simplex keratitis often causes no permanent visual loss but should be treated by a doctor as complications can arise and they can be severe.
Eye pain is often described as burning, sharp, shooting, dull, gritty, a feeling of "something in my eye," aching, pressure, throbbing, or stabbing. Sometimes pain originating from the eye is confused with other symptoms, such as a headache, sinus pain, toothache, or a migraine.
Eye pain is a common reason for people to seek medical care from their doctor (or an ophthalmologist, a medical doctor specializing in the diagnosis and treatment of eye diseases).
