Herpes

What is herpes simplex keratitis (HSV)?

There are lots of names for herpes simplex that affects the cornea: HSV type I keratitis, herpes simplex keratitis, dendritic keratitis, stromal herpes, herpetic endotheliitis, herpetic keratouveitis, and many more. It should not be confused with Varicella zoster virus (VZV) or shingles. It is not uncommon for people to hear the term herpes and jump to the idea that we are taking about a sexually transmitted disease. In the vast majority of ocular herpes infections that is not the case. Most people acquire HSV in childhood during what seems to be a mild cold. It tends to live dormant in the nerves around the brain (the trigeminal ganglion) and is kept quite by the immune system. From time to time, the virus can become active and cause a cold sore or fever blister. In those cases the herpes travels along the nerves to the lips. In other cases the herpes can travel along the nerves to other areas of the skin or the eye. It has been suggested that stress, sunburns, and severe illness among other things are what simulate HSV to become active. These causes have not been definitively proven, but it is prudent to stay away from avoidable causes of stressors to your health if you have experienced herpetic flares in the past.

How do I make herpes simplex keratitis go away?

There is no cure for herpes simplex keratitis. There are medication options for long term prophylactic suppression of the virus to try to decrease the frequency of recurrences. Even one flare of HSV has the potential to cause severe scarring that could require a corneal transplant. The suppressive medications are safe and inexpensive. Therefore, I frequently recommend long term use of antiviral medications to limit the possible serious complications of herpetic corneal infections.

How is herpes simplex keratitis (HSV) treated?

The treatment of herpes simplex keratitis is extremely complex and should be treated by an experienced ophthalmologist. Active herpes infections can persist for months even when properly treated. Research on herpetic keratitis is difficult to perform and tricky to interpret. Recent advancements in treatments of antiviral and steroid medications have been helpful in management of this condition. In some cases, surgery in the form of a corneal transplant is necessary to rehabilitate vision.

Will herpes simplex keratitis cause me to lose my vision or need surgery?

Herpes simplex keratitis is the most common cause of infectious corneal blindness in the United States. This “blindness” is actually severely blurred vision usually caused by corneal scarring. Fortunately, a corneal transplant can be performed if necessary to remove the corneal scar and correct the vision.


What is herpes zoster keratitis (shingles)?

Herpes zoster keratitis, herpes zoster ophthalmicus, shingles, or Varicella zoster virus (VZV) is a different type of corneal herpes infection than herpes simplex keratitis (HSV). Herpes zoster is normally contracted in childhood and recognized as chickenpox. The virus lives dormant in the dorsal root ganglia (central nervous system) and can flare later in life to cause a painful skin rash known as shingles. The locations where the shingles appears and why it flares are not definitively known. However, we do know that shingles outbreaks tend to occur during severe illness, in association with cancer, and in advanced age (usually over 60). When VZV affects the eye it can cause pain, tearing, blurred vision, and corneal scarring. Now, because of the VZV vaccine, many kids don’t actually get chickenpox. We don’t know what this will mean for their chances of shingles outbreaks in the future. It is recommended that adults over the age of 60 get a “shingles booster” to help prevent later outbreaks of shingles. Boosters will likely also be recommended at some time in the future for adults who received the VZV vaccine as children.

How do I get rid of the herpes zoster virus?

There is no cure for herpes. Luckily, herpes zoster does not usually recur on the same area of the body more than once. It terms of the eyes, it can come back in the form of uveitis (inflammation inside the eye) that could require long term management with steroids and antiviral medications. There are treatment options for the uveitis, pain, and blurred vision that can occur due to herpes zoster keratitis.

How is herpes zoster keratitis treated?

Herpes zoster keratitis is treated with topical and oral antiviral medications and in some cases steroids. Because the treatment of VZV is very complex, patients should be under the care of an experienced ophthalmologist. Herpes zoster can also cause scarring of the skin and permanent pain known as post herpetic neuralgia (PHN). Therefore, I frequently refer patients to see a dermatologist and or a pain management specialist.

Will herpes zoster keratitis (VZV) cause me to lose vision or need surgery? 

Medications are used to speed the recovery of patients with herpes zoster keratitis (VZV). In some cases a corneal transplant can be performed to remove the corneal scar and correct the vision. However, patients undergoing corneal transplantation for herpes zoster often have more problems with healing following surgery. For this reason, corneal transplantation for patients with herpes zoster corneal scarring is undertaken much less often than for other forms of corneal scarring.