Herpetic keratoconjunctivitis represents a specific eye infection caused by a virus. This condition affects the conjunctiva, the clear membrane covering the white part of the eye and the inside of the eyelids, as well as the cornea, the transparent front part of the eye. The infection’s viral origin distinguishes it from other types of eye inflammation.
How the Infection Develops
Herpetic keratoconjunctivitis stems from the herpes simplex virus (HSV). While HSV-1 is primarily associated with oral cold sores, and HSV-2 typically causes genital herpes, both can lead to this eye condition. Transmission often occurs through direct contact with an active herpes lesion, such as touching a cold sore and then inadvertently touching the eye. This allows the virus to infect the ocular surface.
Once HSV enters the body, it establishes a dormant state within sensory nerve ganglia, particularly the trigeminal ganglion for ocular infections. This latency means the virus can reside silently in nerve cells for extended periods without causing symptoms. Various factors, including physical or emotional stress, fever, excessive sun exposure, or minor trauma to the eye, can trigger the dormant virus to reactivate. Upon reactivation, the virus travels back down the nerve pathways to the eye, leading to a new episode of infection and inflammation.
Recognizing the Symptoms and Getting a Diagnosis
Symptoms of herpetic keratoconjunctivitis include eye pain, redness, and excessive tearing. Many also report heightened sensitivity to light, known as photophobia, along with blurred vision and a persistent feeling as if something is in the eye. Characteristic lesions caused by the virus may appear on the cornea, often in a branching, tree-like pattern called a dendritic ulcer, or less commonly on the conjunctiva.
Prompt medical attention is important to prevent potential long-term damage. Diagnosis typically begins with a comprehensive eye examination using a slit-lamp microscope to view the eye’s structures. To identify corneal damage, a fluorescein dye may be applied. This dye adheres to disrupted areas of the cornea, making dendritic ulcers visible under a blue light. To confirm the virus, a doctor might collect a sample for viral culture or polymerase chain reaction (PCR) testing.
Managing the Infection
Treatment primarily involves antiviral medications that inhibit virus replication. Common antivirals include acyclovir, ganciclovir, and trifluridine. These medications can be administered topically as eye drops or ointments, or systemically through oral tablets. The choice of administration depends on the severity and specific presentation of the infection. Topical antivirals work by directly targeting the virus on the eye’s surface, while oral medications provide systemic coverage against the viral infection.
Beyond antiviral therapy, supportive care measures can help alleviate discomfort during an active infection. Applying cold compresses can reduce swelling and provide soothing relief. Individuals with an active infection should avoid wearing contact lenses, as they can irritate the eye and potentially prolong healing or worsen the condition. Adherence to the prescribed treatment is important, and regular follow-up appointments with an ophthalmologist are necessary to monitor progress and adjust treatment as needed.
Long-Term Concerns and Preventing Recurrence
Herpetic keratoconjunctivitis can lead to long-term complications, particularly if not managed effectively or if recurrent episodes occur. A significant concern is corneal scarring, where repeated inflammation and healing can leave opaque areas on the cornea. This scarring can impair vision, potentially resulting in permanent vision loss in severe or untreated cases. Recurrent episodes are also a concern, as the herpes simplex virus remains dormant and can reactivate periodically.
Preventing recurrences involves identifying and avoiding known triggers that can prompt the virus to reactivate. Common triggers include stress, fever, prolonged exposure to sunlight or ultraviolet light, and physical injury to the eye. For individuals experiencing frequent or severe recurrences, long-term, low-dose antiviral suppressive therapy may be recommended. This involves taking a daily oral antiviral to reduce the frequency and severity of future outbreaks. Continuous ophthalmic care is important to monitor the eye for chronic issues and to manage potential long-term impacts.