Viral

Etiology: infection due to reactivated herpes simplex virus (HSV) type 1 from the trigeminal ganglion

• Clinical features

  • Similar to viral conjunctivitis, but usually unilateral

  • Eye redness

  • ± Eye pain

  • Foreign body sensation

  • Corneal hypoesthesia

  • Photophobia

  • Blurry vision; can lead to vision loss if untreated

• Diagnostics [5]

  • Fluorescein staining: superficial corneal erosions (dendritic ulcers) that resemble the branches of a tree (geographic ulcers may be seen when dendritic ulcers widen in shape)

  • Direct fluorescein antibody test (HSV antigen detection) or polymerase chain reaction (PCR) test

• Treatment for epithelial HSV keratitis [6]

  • Topical trifluridine solution or ganciclovir 0.15% gel

  • Oral antiviral (e.g., acyclovir) when topical treatment cannot be administered by the patient, prophylactic treatment after surgery, or refractory cases despite topical treatment

  • Corneal transplantation for patients with severe corneal scarring

Glucocorticoids should not be used in initial treatment of dendritic epithelial keratitis!

• Etiology: reactivated herpes zoster virus (involvement of the ophthalmic nerve ); see also herpes zoster ophthalmicus.

• Clinical features

  • Prodrome: headache, malaise, fever

  • Impaired vision

  • Eye irritation (foreign body sensation)

  • Photophobia

  • Eye pain

  • In the innervation area of the ophthalmic nerve (forehead, bridge, and tip of the nose):

    • Vesicular eruption

    • Anesthesia dolorosa

• Diagnostics

  • Slit-lamp examination and fluorescein staining

    • 1–2 days: punctate lesions on the corneal surface

    • 4–6 days: pseudodendritic lesions on the corneal surface

• Treatment: oral acyclovir, valacyclovir, or famciclovir