Herpetic Keratitis is a form of recurrent herpes eye infection and can be divided into two main categories epithelial keratitis and stromal keratitis.
Corneal epithelial layer is the outer most layer of the cornea and when it is infected by herpes, it will show small epithelial defects which will stain with fluorescein.
When these small epithelial defects coalesce, they will form dendritic ulcer which is characteristic for herpes epithelial keratitis. This dendritic corneal ulcer will stain with both fluorescein and rose Bengal stain.
Symptoms of Epithelial Herpetic Keratitis
1- Red eye
2- Blurred vision
3- Eye discharge
4- Light sensitivity or photophobia
5- Foreign body sensation and eye pain
Treatment of Epithelial Herpetic Keratitis
1- Antiviral medications which can be taken as topical and oral medications.
Topical medication usually will not be used for more than 2 weeks because it can cause corneal toxicity. Oral medications can be as effective as topical medication.
Examples of antiviral medications: acyclovir, valacyclovir and trifluridine
2- Epithelial debridement can be very helpful in speeding up the healing.
Complications of Herpetic Epithelial Keratitis
1- Loss or reduction of corneal sensation which is called neurotrophic keratitis.
2- Geographic epithelial ulcer in which the dendritic ulcer will expand to involve a large area of the cornea.The main cause behind this is the application of corticosteroid. Corticosteroid is contraindicated in herpes epithelial eye infection.
3- Cornea scaring and opacity.
Herpetic Stromal Keratitis
In this form of herpes eye infection, there will be inflammation of corneal stromal layer. Stromal layer of the cornea is the middle layer of the cornea. This infection will involve stromal layer without the involvement of epithelial layer and the endothelial layer. Read more about Herpetic Stromal Keratitis.