From the Guidelines

Herpes Simplex Keratitis (HSV) diagnosis is typically based on clinical presentation and treatment involves antiviral medications.

The diagnosis of HSV is usually made based on the patient's symptoms and clinical findings, such as corneal involvement or conjunctivitis.
Treatment options for HSV keratitis include:
- Topical antivirals: ganciclovir 0.15% gel used three to five times per day or trifluridine 1% solution five to eight times per day 1.
- Oral antivirals: acyclovir (200 to 400 mg five times a day), valacyclovir (500 mg two or three times a day), or famciclovir (250 mg twice a day) 1.
It is essential to avoid using topical corticosteroids, as they can potentiate HSV infection 1.
Patients should have a follow-up visit within one week of treatment to assess the response to therapy and adjust the treatment plan as needed 1.
In cases of recurrent HSV keratitis, lower doses of oral antivirals may be considered for long-term prophylaxis 1.

From the Research

Herpes simplex keratitis is a corneal viral infection caused by the herpes simplex virus (HSV) that can affect several tissues, including the cornea 2
The diagnosis of HSV keratitis involves identifying the clinical patterns of the disease, which can range from mild epithelial involvement to more severe stromal or endothelial disease 3
The severity and frequency of recurrences vary among individuals, and severe cases of HSK can result in vision impairment or even blindness in extreme cases 2

The management of HSK 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
Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis 2
Topical artificial tears (if necessary with acyclovir ointment at night) in the quiet interval are recommended to limit the tendency towards recurrences 3
Systemic acyclovir application (2×400 mg/day) for at least 1 year is indispensable after keratoplasty and in cases of severe recurrences of herpetic keratitis 3
Current antiviral therapies target viral replication to decrease disease duration, severity, and recurrence, but there are limitations to these agents 4
Newer medications such as valacyclovir are now available and are considered to have better bioavailability than acyclovir 5

Epithelial keratitis (dendritica/geographica) 3
Stromal keratitis (necrotizing vs. non-necrotizing = "interstitial keratitis") 3
Endotheliitis (=disciform keratitis) 3
Neurotrophic keratopathy (=so-called metaherpetic keratitis) 3
(Vascularized) corneal scars 3

Corneal scarring and neovascularization 4
Ocular pain and subsequent neutrophic keratopathy 4
Corneal opacification due to inflammatory cell infiltrate, angiogenesis, and corneal nerve loss 4
Vision impairment or even blindness in extreme cases 2