Herpes Keratitis
What is Herpes Keratitis?
Herpes keratitis is an infection of the cornea caused by the herpes simplex virus type 1. The cornea is the clear dome covering the front of your eye. When HSV-1 infects this tissue, it causes inflammation and damage that can affect your vision.
This condition is one of the most common causes of infectious blindness in developed countries. HSV-1 is the same virus that causes cold sores on the lips. The virus can spread to your eyes through touch or by reactivating from nerve tissue near your face. Most people with herpes keratitis have had previous cold sores or HSV-1 exposure.
Herpes keratitis can range from mild surface infections to deeper infections that scar the cornea. Early detection and treatment are essential to prevent permanent vision damage. The infection can come back even after successful treatment because the virus stays dormant in your nerve cells.
Symptoms
- Eye pain that can be severe
- Redness and irritation in the eye
- Blurred or cloudy vision
- Sensitivity to light
- Watery discharge from the eye
- Feeling like something is in your eye
- Eye tearing
- Swollen eyelids
Some people may have mild symptoms at first and not realize they have an infection. Symptoms can develop suddenly or come on gradually over several days. The infection usually affects one eye but can occasionally involve both eyes.
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Causes and risk factors
Herpes keratitis is caused by HSV-1, the virus that typically causes cold sores. The virus enters the eye through direct contact, such as touching a cold sore and then touching your eye. The virus can also travel along nerve pathways from other parts of your body to reach your eye. Once you have HSV-1, it stays in your body forever in a dormant state inside nerve cells.
Several factors can trigger the dormant virus to reactivate and cause herpes keratitis. These include stress, illness, fever, sun exposure, trauma to the eye, and weakened immune function. People who wear contact lenses have a higher risk of developing the condition. Eye surgery or other eye injuries can also trigger reactivation. A weakened immune system from illness or medications makes recurrence more likely.
How it's diagnosed
An eye doctor diagnoses herpes keratitis through a comprehensive eye exam. They use a special microscope called a slit lamp to examine your cornea closely. A fluorescent dye may be placed in your eye to highlight damaged areas. The infection often creates a distinctive branching pattern on the cornea that can be seen with this examination.
Blood tests can detect antibodies to HSV-1, showing whether you have been exposed to the virus. HSV-1 IgG antibodies indicate past infection, while HSV-1 IgM antibodies may suggest recent or active infection. However, eye examination remains the primary way to diagnose herpes keratitis. Talk to your doctor about testing if you have symptoms or a history of HSV-1 infections.
Treatment options
- Antiviral eye drops or ointments to fight the infection
- Oral antiviral medications like acyclovir or valacyclovir
- Steroid eye drops in some cases to reduce inflammation
- Avoiding contact lenses until the infection clears
- Managing stress through relaxation techniques and adequate sleep
- Protecting eyes from sun exposure with sunglasses
- Long-term suppressive antiviral therapy to prevent recurrences
- Corneal transplant surgery in severe cases with scarring
See an eye doctor immediately if you have eye pain, redness, or vision changes. Prompt treatment can prevent serious complications and vision loss. Never use steroid eye drops without medical supervision, as they can make herpes infections worse.
Frequently asked questions
Pink eye is usually caused by bacteria or viruses that affect the outer membrane of the eye. Herpes keratitis specifically infects the cornea itself and is caused by HSV-1. Herpes keratitis typically causes more pain and can lead to vision loss if untreated, while pink eye is usually milder and resolves without affecting vision.
Yes, herpes keratitis can cause permanent vision loss if not treated promptly or if infections recur multiple times. Each infection can create scarring on the cornea that affects how light enters the eye. With early treatment, most people recover good vision. Severe cases may require corneal transplant surgery to restore sight.
Surface infections typically heal within 1 to 2 weeks with proper antiviral treatment. Deeper infections affecting inner layers of the cornea can take several weeks or months to heal completely. Your doctor will monitor healing through regular eye exams. Follow-up care is important even after symptoms improve.
You can get HSV-1 infection through direct contact with someone who has active cold sores or herpes lesions. However, herpes keratitis itself is not directly contagious from eye to eye. The virus typically spreads when you touch an infected area and then touch your own eye. Avoid sharing towels, eye makeup, or contact lens supplies.
Yes, herpes keratitis can recur because the virus remains dormant in your nerve cells. About one-third of people experience at least one recurrence. Your doctor may prescribe long-term suppressive antiviral medication if you have frequent recurrences. Managing stress and avoiding triggers can help reduce the risk of future episodes.
You must stop wearing contact lenses during active herpes keratitis infection. Contact lenses can make the infection worse and delay healing. Your eye doctor will tell you when it is safe to resume wearing contacts, usually several weeks after complete healing. Some people may need to switch to glasses permanently to reduce recurrence risk.
Blood tests can detect HSV-1 IgG and IgM antibodies to show exposure to the virus. HSV-1 IgG indicates past infection, while IgM may suggest recent or active infection. However, these blood tests cannot diagnose herpes keratitis directly. Eye examination by a doctor remains the primary diagnostic method for this eye condition.
Take prescribed antiviral medication as directed, even between outbreaks if recommended. Manage stress through adequate sleep and relaxation practices. Protect your eyes from sun exposure with quality sunglasses. Avoid touching your eyes after touching cold sores or other lesions, and wash your hands frequently.
Yes, stress is one of the most common triggers for herpes keratitis recurrence. Physical or emotional stress weakens your immune system, allowing the dormant virus to reactivate. Other triggers include illness, fever, sun exposure, and eye trauma. Managing stress and maintaining overall health can help reduce outbreak frequency.