From the Guidelines
Herpes Simplex Virus (HSV) keratitis typically presents with symptoms such as unilateral bulbar conjunctival injection, watery discharge, mild follicular reaction of conjunctiva, and distinctive signs including vesicular rash or ulceration of eyelids, and pleomorphic or excavated dendritic epithelial keratitis of the cornea.
Key Symptoms
- Unilateral bulbar conjunctival injection
- Watery discharge
- Mild follicular reaction of conjunctiva
- Vesicular rash or ulceration of eyelids
- Pleomorphic or excavated dendritic epithelial keratitis of the cornea
Clinical Considerations
The symptoms of HSV keratitis can be similar to those of other forms of conjunctivitis, but the presence of distinctive signs such as dendritic epithelial keratitis can help with diagnosis 1.
Treatment and Management
Treatment for HSV keratitis typically involves topical or oral antiviral medications, such as ganciclovir 0.15% gel or acyclovir 200 to 400 mg five times per day, and may require follow-up visits to monitor progression and adjust treatment as needed 1.
Important Considerations
- Topical corticosteroids should be avoided as they can potentiate HSV infection 1
- Lower doses of oral antivirals may be considered for long-term prophylaxis against recurrent HSV keratitis 1
From the Research
Symptoms of Herpes Simplex Virus (HSV) Keratitis
The symptoms of Herpes Simplex Virus (HSV) keratitis can vary in severity and presentation. Some common symptoms include:
- Ocular pain 2
- Inflammation of the cornea 3, 4, 2, 5, 6
- Corneal scarring and neovascularization 4, 2, 5, 6
- Decreased corneal sensation 5
- Recurrent episodes of inflammation and damage to the cornea 3
- Vision impairment or blindness in severe cases 3, 4, 5, 6
- Epithelial involvement, ranging from mild to severe stromal or endothelial disease 3
Clinical Presentation
The clinical presentation of HSV keratitis can be variable, ranging from mild epithelial involvement to more severe stromal or endothelial disease 3. The diagnosis of HSV keratitis can be problematic, and accurate diagnosis is necessary for proper treatment 5.
Triggers and Reactivation
Factors that can trigger reactivation of the virus include: