Herpes Simplex Keratitis

Overview & Causes

● A viral infection caused by the Herpes Simplex Virus (HSV) that leads to a
chronically red and irritated eye.
● It primarily produces characteristic dendritic lesions on the corneal epithelium.
● Patients often have a history of cold sores, genital herpes, or previous keratitis. It
can become exceptionally severe in atopic patients (a condition called eczema
herpeticum).

Signs & Symptoms

● Ocular Presentation: Redness, irritation, and dendritic corneal ulcers (which
become visible when using fluorescein dye and blue light). A hypopyon (pus)
may appear if there is intraocular inflammation.
● Physical Features: Swollen eyelids, eye discharge, associated papillary
conjunctivitis, and a vesicular rash on the face or eyelids (often preceded by a
24-hour tingling sensation).

Management & Precautions

● Immediate Action: Suspected cases require immediate medical referral.
● Treatment Options: Treated with topical antivirals (e.g., aciclovir cream applied
five times daily for five days) or oral antivirals (aciclovir, famciclovir, or
valaciclovir). Antibiotics are prescribed if a secondary bacterial infection
develops.
● Strict Warning: Topical steroids must be completely avoided. Using them
inadvertently can cause the ulcers to rapidly spread and deepen.