Can ocular Herpes Simplex Virus (HSV) cause yellow crusting?

From the Guidelines

Yes, ocular Herpes Simplex Virus (HSV) infection can cause yellow crusting around the eyes. This crusting typically forms when the clear fluid from herpes blisters or ulcers dries and mixes with inflammatory cells and debris. Ocular HSV most commonly affects the cornea (herpes keratitis) or the eyelids and surrounding skin (herpes blepharitis) [ 1 ]. When the infection involves the eyelids, patients may notice small blisters that rupture, weep fluid, and form yellowish crusts along the lid margins. This crusting is often accompanied by redness, pain, light sensitivity, tearing, and sometimes blurred vision.

Key Points to Consider

• The yellow crusting occurs because the virus triggers an inflammatory response, causing immune cells to migrate to the infection site, creating exudate that dries into crusts [ 1 ].
• If you notice these symptoms, seek immediate eye care as HSV eye infections require prompt treatment, typically with antiviral medications such as topical ganciclovir gel, trifluridine drops, or oral antivirals like acyclovir (200-400mg five times daily), valacyclovir (500mg two or three times daily), or famciclovir (250mg twice daily) for 7-10 days [ 1 ].
• Never attempt to forcibly remove these crusts as this may damage the delicate skin and potentially spread the infection.

Treatment and Follow-Up

• Treatment is usually instigated upon high suspicion or concomitant corneal involvement [ 1 ].
• Within 1 week of treatment, patients should have a follow-up visit consisting of an interval history, visual acuity measurement, and slit-lamp biomicroscopy [ 1 ].
• Topical corticosteroids potentiate HSV infection and should be avoided [ 1 ].

From the Research

Ocular Herpes Simplex Virus (HSV) Infection

• Ocular HSV infection can cause various clinical manifestations, including epithelial keratitis, stromal keratitis, and uveitis 2.
• The infection can lead to the development of dendritic or geographic ulcers on the corneal epithelium, which may progress to noninfective indolent or trophic ulcers 2.

Yellow Crusting in Ocular HSV Infection

• There is no direct evidence in the provided studies that specifically mentions yellow crusting as a symptom of ocular HSV infection.
• However, the studies do mention the development of vesicular blepharitis, which can progress to infectious epithelial keratitis despite treatment with oral acyclovir 3.
• It is possible that yellow crusting may be a symptom of a secondary bacterial infection or another condition that can occur in conjunction with ocular HSV infection.

Treatment of Ocular HSV Infection

• Antiviral agents, such as trifluridine, acyclovir, and vidarabine, are effective in treating ocular HSV infection, particularly epithelial keratitis 4, 3, 5.
• The combination of topical antiviral therapy with physicochemical methods, such as débridement, may be more effective than antiviral therapy alone 4, 5.
• Acyclovir remains the gold standard in the treatment of herpes virus infections, including ocular HSV infection, due to its effectiveness and the development of new delivery systems that improve its bioavailability 6.