R R

What Is Viral Keratitis?

Viral keratitis is inflammation or infection of the cornea caused by viruses, most often herpes simplex virus, varicella zoster virus, or adenoviruses. The virus can involve the epithelium, stroma, or endothelium, creating different patterns of damage. Symptoms include redness, pain, tearing, and light sensitivity, with variable levels of blur. Herpes simplex tends to recur and can slowly scar the cornea over time. Early diagnosis and targeted therapy lower the risk of permanent vision changes.

Link to This Resource Page

Provide a valuable resource to your clients or customers by linking to this resource page. Just place the following link on your website.

To display this...

What Is Viral Keratitis?

Viral keratitis is inflammation or infection of the cornea caused by viruses, most often herpes simplex virus, varicella zoster virus, or adenoviruses. The virus can involve the epithelium, stroma, or endothelium, creating different patterns of damage. Symptoms include redness, pain, tearing, and light sensitivity, with variable levels of blur. Herpes simplex tends to recur and can slowly scar the cornea over time. Early diagnosis and targeted therapy lower the risk of permanent vision changes.

read more about viral keratitis ...

Copy this HTML:

Copy HTML Copied!

Common Causes and Types of Viral Keratitis

Herpes simplex virus type 1 causes classic dendritic epithelial ulcers and can progress to stromal or endothelial disease. Varicella zoster affects the cornea in herpes zoster ophthalmicus and can create pseudodendrites, stromal infiltrates, or neurotrophic keratopathy. Adenoviruses cause epidemic keratoconjunctivitis, with subepithelial infiltrates that blur vision even after redness settles. Less common viral causes include enteroviruses and others in systemic infections. The pattern of lesions and systemic history help distinguish these types.

Symptoms and Clinical Features

Patients often report foreign body sensation, watering, and marked light sensitivity. Pain can range from mild to severe, especially in zoster related disease. On slit lamp exam, epithelial herpes shows branching dendritic or geographic ulcers with terminal bulbs. Stromal disease presents with haze, infiltrates, or disciform edema, and endothelial keratic precipitates can be seen. Adenoviral keratitis creates multiple subepithelial infiltrates that reduce contrast. Corneal sensation is often reduced in herpes simplex infection.

How Is Viral Keratitis Diagnosed?

Diagnosis is mostly clinical, based on characteristic lesion patterns and history. The eye doctor checks for skin or lid lesions, prior episodes, and recent viral illness. Fluorescein and rose bengal staining highlight dendrites or pseudodendrites. PCR testing of tear or corneal samples is used in some uncertain or severe cases, especially in atypical zoster or in immunocompromised patients. Distinguishing viral keratitis from bacterial or fungal disease is important because treatments differ.

How Is Viral Keratitis Treated?

Treatment depends on the virus and the layers involved. Epithelial herpes simplex keratitis is usually treated with topical or oral antivirals, while topical steroids are avoided until the epithelium heals. Stromal or endothelial herpetic disease often needs a combination of topical steroids and systemic antivirals under close supervision. Adenoviral keratitis is managed mainly with lubricants, cold compresses, and sometimes mild topical steroids for significant infiltrates. Long term oral antivirals are used in recurrent herpes to cut down future flares.

FAQs About Viral Keratitis

Is viral keratitis contagious?

Herpes and adenoviral infections can spread through contact with tears or lesions, so hand hygiene and avoiding sharing towels or cosmetics are important. The corneal inflammation itself is local, but the underlying virus can pass to others.

Can viral keratitis cause permanent vision loss?

Yes, repeated or severe episodes can leave stromal scars, irregular astigmatism, or chronic dry eye that limit vision. Early treatment and regular follow up help reduce long term damage.

Why are steroids sometimes dangerous in viral keratitis?

In active epithelial herpes, steroids can boost viral replication and worsen ulcers. They are reserved for deeper inflammatory disease and always paired with antiviral therapy when herpes is involved.

Will I keep having herpes flare ups once I get viral keratitis?

Herpes simplex keratitis often recurs because the virus stays latent in the trigeminal ganglion. Long term low dose oral antivirals are sometimes used to reduce the frequency and severity of future episodes.