Herpes Simplex Keratitis
What is Herpes Simplex Keratitis?
Herpes simplex keratitis is a viral infection of the cornea caused by herpes simplex virus type 1. The cornea is the clear front layer of your eye that helps focus light. When HSV-1 infects the cornea, it causes inflammation and damage that can blur vision or lead to permanent scarring.
This condition is the leading infectious cause of corneal blindness in developed countries. Most people catch HSV-1 during childhood through casual contact like kissing or sharing utensils. The virus stays dormant in nerve cells and can reactivate later in life, traveling to the eye and causing keratitis.
Herpes simplex keratitis can affect different layers of the cornea. The most common form is epithelial keratitis, which affects the surface layer and often creates a branching pattern called dendritic ulcer. Deeper infections called stromal keratitis damage the middle layer and carry higher risk of vision loss. Quick treatment is essential to protect your sight.
Symptoms
- Eye pain or discomfort that may feel sharp or burning
- Redness and irritation in the affected eye
- Blurred or decreased vision
- Sensitivity to light, also called photophobia
- Excessive tearing or watery discharge
- Feeling like something is stuck in your eye
- White or cloudy spot on the cornea
- Swelling of the eyelid
Symptoms usually affect only one eye. Some people experience mild symptoms at first and may delay seeking care. Early treatment is critical to prevent permanent damage, so see an eye doctor immediately if you notice any vision changes or eye pain.
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Causes and risk factors
Herpes simplex keratitis happens when herpes simplex virus type 1 reactivates and travels along nerve pathways to reach the eye. Most adults carry HSV-1 from childhood infections, often caught through casual contact. The virus lies dormant in nerve tissue near the face and can wake up when your immune system is weakened or stressed.
Common triggers for reactivation include illness or fever, emotional or physical stress, sunlight or UV exposure, eye injury or surgery, and immune system problems. People who take steroids or have conditions that weaken immunity face higher risk. Once you have had one episode, the virus can reactivate multiple times throughout life. Each recurrence increases the risk of corneal scarring and permanent vision damage.
How it's diagnosed
An eye doctor diagnoses herpes simplex keratitis through a detailed eye exam using a slit lamp microscope. This tool magnifies the cornea and reveals characteristic patterns like branching dendritic ulcers that look like tree branches. Your doctor may apply fluorescein dye to make corneal damage easier to see under special blue light.
Blood testing for Herpes Simplex Virus 1 IgG antibodies can confirm past exposure to HSV-1 and support the diagnosis of herpetic eye disease. Rite Aid offers HSV-1 IgG testing as an addon to help you understand your infection status. A positive result shows your immune system has encountered the virus, which is important context when evaluating eye symptoms. Your eye doctor may also take a sample from the cornea for lab testing if the diagnosis is unclear.
Treatment options
- Antiviral eye drops or ointments like trifluridine or ganciclovir to stop virus replication
- Oral antiviral medications such as acyclovir or valacyclovir for deeper or recurrent infections
- Long-term suppressive antiviral therapy to prevent recurrences if you have multiple episodes
- Avoid touching or rubbing your eyes to prevent spreading the virus
- Manage stress through regular sleep, healthy eating, and relaxation practices
- Wear sunglasses to protect against UV light triggers
- Never use steroid eye drops without your doctor's guidance, as they can make the infection worse
- Follow up regularly with your eye doctor to monitor healing and catch recurrences early
Treatment must start quickly to protect your vision. Your eye doctor will tailor your treatment based on which corneal layers are affected. Most surface infections heal within a few weeks with proper antiviral treatment. Deeper stromal infections may require months of care and carry higher risk of scarring.
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Frequently asked questions
Herpes simplex keratitis is a viral infection of the cornea caused by HSV-1 that can permanently damage vision. Pink eye, or conjunctivitis, affects the outer membrane covering the white of the eye and usually causes redness and discharge without vision loss. Herpes keratitis typically affects only one eye and causes more pain and light sensitivity than pink eye. An eye doctor can tell the difference through examination and prescribe the right treatment.
Yes, herpes simplex keratitis is the leading infectious cause of corneal blindness in developed countries. Repeated infections can cause scarring that permanently clouds the cornea and blocks vision. Stromal keratitis, which affects deeper layers, carries the highest risk of lasting damage. Early treatment with antiviral medications and regular monitoring by an eye doctor greatly reduce the risk of vision loss.
A blood test for HSV-1 IgG antibodies can show if your immune system has been exposed to the virus. Most adults test positive because HSV-1 is very common and spreads through casual contact in childhood. Rite Aid offers HSV-1 IgG testing as an addon to help you understand your exposure status. A positive test means you carry the virus and could potentially develop herpetic eye disease if it reactivates.
Yes, physical or emotional stress is one of the most common triggers for HSV-1 reactivation. Stress weakens your immune system and allows the dormant virus to wake up and travel to your eye. Other triggers include illness, fever, sunlight, eye trauma, and medications that suppress immunity. Managing stress through good sleep, nutrition, and relaxation can help reduce your risk of recurrence.
Surface infections, called epithelial keratitis, usually heal within 1 to 3 weeks with antiviral treatment. Deeper stromal infections take longer, often several months, and may leave some scarring. Healing time depends on how quickly you start treatment and whether you have had previous episodes. Your eye doctor will monitor your progress and adjust treatment as needed.
No, you should not wear contact lenses during active infection or while using antiviral eye medications. Lenses can trap virus particles and medication against your cornea, slowing healing and increasing damage risk. Wait until your eye doctor confirms the infection has fully healed and gives you clearance to resume lens wear. Some people with recurrent infections may need to switch to glasses permanently.
Herpes simplex keratitis often recurs because the virus stays in your body for life. About half of people who have one episode will have another within 10 years. Each recurrence increases the risk of corneal scarring and vision problems. Your doctor may prescribe long-term suppressive antiviral medication to prevent future episodes if you have frequent recurrences.
The virus can spread to other people through direct contact with active sores or secretions. However, herpes simplex keratitis itself is not highly contagious compared to oral herpes cold sores. You can reduce transmission risk by washing your hands frequently, not touching your eyes, and avoiding sharing towels or eye products. The virus does not spread through casual contact or air.
You cannot eliminate HSV-1 once infected, but you can reduce reactivation risk through healthy habits. Get adequate sleep, manage stress, eat a balanced diet, and protect your eyes from UV light with sunglasses. If you have had multiple episodes, your doctor may prescribe daily suppressive antiviral medication. Regular eye exams help catch recurrences early when treatment is most effective.
Steroid eye drops reduce inflammation but also suppress local immune response, allowing the virus to multiply and spread more easily. Using steroids without antiviral coverage can make herpes keratitis much worse and lead to deeper corneal damage. Your eye doctor may use steroids carefully for stromal keratitis, but only after controlling the active virus with antivirals. Never use steroid drops without specific guidance from your eye care provider.