The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Herpes Simplex Keratitis (HSV Keratitis)

Recurrent corneal infection by herpes simplex virus causing dendritic ulcers and stromal scarring.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Herpes Simplex Keratitis (HSV Keratitis)?

Herpes simplex virus (mostly HSV-1) establishes latency in the trigeminal ganglion after primary infection and reactivates to involve the cornea. Five clinical forms occur: epithelial keratitis (dendritic and geographic ulcers), stromal keratitis (necrotizing or non-necrotizing immune-mediated interstitial), endothelial keratitis (disciform), neurotrophic (metaherpetic) keratopathy, and combined forms. Each recurrence increases risk of corneal scarring, neovascularization, and visual loss.

Diagnosis is clinical with characteristic dendritic lesions stained by fluorescein and rose Bengal; PCR of corneal scrapings or aqueous tap (in stromal/endothelial disease) confirms diagnosis. Slit-lamp shows decreased corneal sensation, terminal bulbs on dendrites, immune ring, ghost vessels, and Wessely ring in stromal disease. Differential includes adenoviral keratitis, varicella zoster, Acanthamoeba, and dry eye.

Treatment of epithelial disease uses topical ganciclovir 0.15% gel five times daily or oral valacyclovir 1 g three times daily for 7-10 days; topical steroids are contraindicated in active dendritic disease. Stromal and endothelial keratitis combine oral antivirals with cautious topical corticosteroids tapered slowly. Long-term suppression with oral acyclovir 400 mg twice daily or valacyclovir 500 mg daily reduces recurrences (HEDS trial). Neurotrophic ulcers require autologous serum, amniotic membrane, or tarsorrhaphy.

Symptoms

Unilateral red painful eye
Photophobia and tearing
Foreign body sensation
Decreased corneal sensation
Dendritic or geographic epithelial ulcer
Stromal haze with neovascularization
Reduced vision and recurrent episodes

Risk Factors

Prior episode of HSV keratitis
Topical or systemic immunosuppression
UV exposure and ocular surgery
Contact lens wear with epithelial trauma
Atopic disease and stress
Trigeminal ganglion latency reactivation
Postpartum and febrile illness

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New unilateral red painful eye with photophobia
  • Recurrent episodes of corneal ulcer
  • Decreased vision with stromal haze
  • Persistent epithelial defect after antivirals
  • Worsening despite topical steroids in unrecognized HSV

Treatment Methods

01
Slit-lamp with fluorescein and corneal sensation
02
Topical ganciclovir or oral valacyclovir for epithelial
03
Oral antiviral plus cautious topical steroid for stromal
04
Long-term oral antiviral suppression
05
Autologous serum and amniotic membrane for neurotrophic
06
Penetrating keratoplasty for end-stage scarring
07
Avoid topical steroids in active dendritic disease

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Göz Hastalıkları Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Anaemia

Dahiliye (İç Hastalıkları)

Anaemia is a low haemoglobin level that reduces oxygen delivery, causing fatigue, pallor, and shortness of breath. It is not a disease itself but a sign of many underlying conditions. Most cases are correctable with appropriate diagnosis and treatment.

Iron Deficiency Anaemia

Dahiliye (İç Hastalıkları)

Iron deficiency anaemia develops when dietary intake, absorption, or losses create an iron shortfall, most often affecting women and children. Identifying the underlying cause is the core of management, alongside iron replacement.

Vitamin B12 Deficiency

Dahiliye (İç Hastalıkları)

Vitamin B12 deficiency can cause megaloblastic anaemia, neurological symptoms, and cognitive impairment. Early treatment with intramuscular or oral B12 largely prevents irreversible complications.

Hypertension (High Blood Pressure) Management

Dahiliye (İç Hastalıkları)

Hypertension is often called the silent killer because it progresses symptom-free for years and can damage the heart, brain, kidneys, and eyes. Regular monitoring, lifestyle change, and evidence-based drug therapy dramatically reduce cardiovascular risk.

Chronic Kidney Disease

Dahiliye (İç Hastalıkları)

Chronic kidney disease is one of the most common complications of chronic conditions such as diabetes and hypertension, and can be silent in its early stages.

Hepatitis B (HBV)

Dahiliye (İç Hastalıkları)

Hepatitis B is a DNA virus infection causing acute and chronic hepatitis with risk of cirrhosis and hepatocellular carcinoma; diagnosis integrates HBsAg, HBeAg, anti-HBc, and HBV DNA with management based on disease phase using nucleos(t)ide analogues (entecavir, tenofovir) and universal infant vaccination.

Hepatitis C (HCV)

Dahiliye (İç Hastalıkları)

Hepatitis C is an RNA virus causing chronic hepatitis that may progress to cirrhosis and hepatocellular carcinoma; modern direct-acting antiviral (DAA) pangenotypic regimens (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) achieve sustained virologic response over 95% in 8–12 weeks with universal adult screening and cure for nearly all patients.

Fatty Liver Disease

Dahiliye (İç Hastalıkları)

Non-alcoholic fatty liver disease (NAFLD) is closely related to obesity and metabolic syndrome and is largely reversible with early treatment.

Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.