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Herpes Simplex Keratitis

(Herpes Simplex Keratoconjunctivitis)

By Melvin I. Roat, MD, FACS, Clinical Associate Professor of Ophthalmology; Cornea Service, Sidney Kimmel Medical College at Thomas Jefferson University; Wills Eye Hospital

Herpes simplex keratitis is an eye infection that involves the cornea (the clear layer in front of the iris and pupil) caused by herpes simplex virus.

Locating the Cornea

The herpes simplex virus (which causes cold sores) never leaves the body after an initial (primary) infection. Instead, the virus remains in a dormant (inactive) stage in the nerves. Sometimes, the virus reactivates and causes further symptoms.

Primary herpes simplex eye infections usually occur in children and cause a mild keratoconjunctivitis, which is inflammation of the cornea and of the conjunctiva (the membrane that lines the eyelids and covers the white of the eye).

The primary infection resolves without treatment. However, if the infection reactivates, it can affect the cornea more seriously and cause more severe symptoms.


Symptoms of primary herpes simplex eye infections usually resemble those of common conjunctivitis, so the diagnosis of herpes simplex infection is not made.

Symptoms of a reactivation include eye pain, tearing, redness, a feeling like a foreign object is in the eye (foreign body sensation), and sensitivity to bright light. Rarely, the infection worsens and the cornea swells, making vision hazy. The more often the infection recurs, the more likely is further damage to the surface of the cornea. Several recurrences may result in the formation of deep ulcers, permanent scarring, and numbness of the eye surface.

The herpes simplex virus can also cause blood vessels to grow onto the cornea and, occasionally, can lead to significant visual impairment.


  • An eye examination

  • Sometimes a culture

To diagnose a herpes simplex infection, a doctor examines the eye with a slit lamp. During the examination, the doctor may put drops in the eyes that contain a yellow-green dye called fluorescein. The fluorescein dye temporarily stains the damage in the cornea a bright green, making it possible for the doctor to see a damaged area that is not otherwise visible.

Sometimes, the doctor may swab the infected area to identify the virus (viral culture).


  • Antiviral eye drops

  • Antiviral drugs taken by mouth or vein

  • Corticosteroid eye drops and drops that dilate the eye

  • Sometimes removal of infected and damaged eye cells

Treatment of herpes simplex keratitis should be started as soon as possible.

The doctor may prescribe an antiviral eye drop, such as trifluridine or ganciclovir.

Acyclovir, another antiviral drug, can be taken by mouth or by vein (intravenously). The antiviral drug valacyclovir can also be taken by mouth.

Deep infections that cause a lot of inflammation may require use of corticosteroid drops and drops that dilate the eye, such as atropine or scopolamine.

Occasionally, to help speed healing, an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders) gently swabs the cornea with a soft cotton-tipped applicator to remove infected and damaged cells.

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