Southwest, FL | Case of the Day - Herpes Eye Infection | Cataract & Refractive Institute of Florida

Dr. Croley: Hello and welcome to case of the day. I'm Dr. Crowley, and today we're going to discuss an interesting case where a young lady came in, and she's had a chronic history of herpes keratitis. That is the cold sore type of fever blister, the herpes simplex, got into her eye just like you can get one on your lip or your nose or inside your mouth, and this time it happened in her eye, and she's had it in a chronic manner. And she came back in today with another episode.

Dr. Croley: So, what is herpes keratitis from herpes simplex? Like I said, it's the same virus that causes the cold sores. And what happens is as classically you'd get a lesion on your cornea. That's the clear part of your eye, and you get a lesion on the surface of your cornea, and it looks like what we described as a dendrite.

Dr. Croley: So what does that look like? It looks like a river with all these tributaries or creeks coming in. So, that's what looks like a dendrite. And so that's the classic sign of herpes keratitis is a dendrite.

Dr. Croley: What we do with that is there's antiviral medicines or eyedrops we put patients on and that typically will take care of it. There are some cases that become difficult to treat, but we'll go into that later.

Dr. Croley: In just general terms, when someone comes in with herpes keratitis, about one-third of people will get that one time in their life, in their eye and never get it again. About another third of people get it a second time and never get it again. But then you have about a third of patients who come in who get it in a recurring, chronic matter, which is what happened in her case, and so then that becomes more difficult to treat.

Dr. Croley: When it's just on the front surface of the corneal layers then it really doesn't scar the eye. You have the episode of pain, your eye's red and irritated, and once that heals and goes away, then you're okay again. It's what happens after repeated episodes of infections that gets deeper into the layers below the epithelium of the cornea and then it gets into the deeper layer and starts causing damage or scarring in the deeper layer of your cornea. And that becomes a problem because if it happens in the middle part of your cornea, where the pupil is, it will start blurring your vision or causing loss of vision. And so we don't want that to happen.

Dr. Croley: And so that stromal layer, the deeper layer, we're not sure what causes that, whether that is there is still some inactive virus particles that hang around in the cornea that reactivate occasionally or whether there's dead virus particles lying inside the cornea, and your immune system reacts to that because the treatment for the deeper layer is actually to put someone on cortisone, but you have to treat them with the antiviral at the same time or you'll get an eruption of the surface part again.

Dr. Croley: And, so this person has had chronic, recurring infections and getting scarring of their cornea. Now some, in that case, when it's recurring, a lot of times we put people on antivirals by mouth. That is we get systemic antivirals they take every day to try to keep these recurring infections from popping up. A lot of people are not very happy with taking a systemic antiviral medicine for the rest of their life, but that is certainly the common way of treating recurrent herpes keratitis.

Dr. Croley: Another method that I have used with success, instead of taking it systemically, we keep them on the eyedrops maybe once a day of the antiviral, and that keeps it under control and keeps the recurrence from coming back.

Dr. Croley: So, if you have a herpes infection in your eye, it needs to be treated immediately because you don't want the deeper layers to get infected. And if you start getting recurrences, then you're going to have to go on maintenance therapy of some sort. Classically that's going to be antiviral systemically by mouth, or an alternative is to put the antiviral drop in your eye. But that's a chronic thing you have to continually do.

Dr. Croley: So, if you have any questions about herpes keratitis or how herpes infects the eye, you can try to contact us through the website, and we'll try to answer any questions you have. If not, may God bless you with healthy eyes and great vision.