From the Guidelines
The chance of developing herpetic keratitis in the other eye is relatively low, and patients should be aware of the potential risks and take preventive measures. According to the study published in the journal Ophthalmology in 2024 1, herpes simplex virus (HSV) typically affects one eye, but bilateral involvement can occur, especially in atopic, pediatric, or immunocompromised patients. Some key points to consider include:
- The natural history of HSV infection usually subsides without treatment within 4 to 7 days unless complications occur
- Potential sequelae of HSV infection include blepharitis, epithelial keratitis, corneal edema, endotheliitis, stromal keratitis, neovascularization, scarring, thinning, perforation, uveitis, trabeculitis, and retinitis
- To reduce the risk of infection in the unaffected eye, proper hygiene practices are essential, including thorough handwashing after touching the affected eye and using separate towels and washcloths
- Patients with recurrent herpes keratitis may benefit from prophylactic antiviral medications, especially during periods of stress, UV exposure, or illness which can trigger viral reactivation Regular eye examinations are important for early detection and treatment of any potential infection in the unaffected eye, as the virus remains dormant in the trigeminal ganglion after initial infection and can reactivate along the same nerve pathway or through autoinoculation to the other eye.
From the Research
Herpetic Keratitis Overview
- Herpetic keratitis is a corneal viral infection caused by the herpes simplex virus (HSV) that can affect several tissues, including the cornea 2.
- The virus can establish a latent infection in the trigeminal ganglion, a nerve cluster near the eye, and may remain dormant for extended periods before reactivating and causing recurrent episodes of herpetic keratitis 2.
Risk of Bilateral Herpetic Keratitis
- Simultaneously occurring bilateral herpetic keratitis is a rare clinical manifestation of ocular herpes, and immunocompromised patients are more susceptible to develop bilateral disease 3.
- The incidence and risk factors of bilateral herpetic keratitis have been reviewed in recent literature, highlighting the importance of understanding the correlations to the disease and new therapeutic options 3.
Recurrence and Reactivation
- Recurrent episodes of herpetic keratitis can manifest in different clinical patterns, ranging from mild epithelial involvement to more severe stromal or endothelial disease 2.
- Factors triggering reactivation of the virus include stress, illness, immunosuppression, or trauma, and the severity and frequency of recurrences vary among individuals 2.
- Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis to prevent recurrences and minimize the risk of reactivation 2, 4.
Treatment and Management
- The management of herpetic keratitis involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization 2.
- Topical antiviral therapy appeared to enable resolution of HSV epithelial keratitis that arose during oral acyclovir treatment, and oral valganciclovir may present an alternative for the treatment and prophylaxis of HSV keratitis in case of treatment-related side effects or failure with conventional antiviral therapies 5, 6.