Herpetic Ceratitis

DEFINITION: It is the infection developing as a result of the confrontation of the cornea located on the front surface of the eye with herpes simplex virus.

SYMPTOMS AND FINDINGS: Watering of the eye, pain (not severe), redness, and blurred vision may occur.

Figure 1. Two faces of herpetic corneal infections; geographic ulceration from either topical steroid abuse or low immunity (left), stromal keratitis due to reactivation of the virus from latency leading to recurrent bouts of corneal inflammation and scarring with progressive loss of vision (right).

CAUSES AND RISK FACTORS: At the first confrontation with the virus, the patient does not have any symptoms or has a clinical picture of blepharo-conjunctivitis where the skin and conjunctiva are involved. Reactivated by attenuation in immunity, the virus may cause an artificial infection in the cornea like epithelial ceratitis or may cause ceratitis that can create serious visiual problems by involving deeper corneal tissues.

AUXILIARY INVESTIGATIONS AND DIAGNOSIS: Diagnosis is made through biomicroscopic examination. The cornea can also be colored with fluorescent dye or rose Bengal dye to detect the ulcer typically in the shape of a branch of dead wood.