Herpes Simplex Virus Keratitis – Diagnostic and Therapeutic Challenges

Herpes simplex virus keratitis is one of the leading causes of blindness worldwide. The observed inflammatory changes may result from a primary ocular infection or, more commonly, from recurrent reactivation of the virus, which remains latent in the trigeminal ganglion. The diagnosis of clinically active herpetic eye disease is based primarily on the characteristic clinical features of the lesions. Clinical manifestations include epithelial keratitis, stromal keratitis with or without ulceration, and endothelial keratitis. In addition, herpes simplex virus is a frequent cause of neurotrophic keratopathy. Establishing the diagnosis may be particularly challenging in cases of long-standing or frequently recurrent lesions, as well as in patients with coexisting systemic conditions that impair immune function. Currently, the cornerstone of therapy for herpetic keratitis – tailored to the clinical form of the disease – consists of antiviral agents and topical corticosteroids. This paper summarizes current knowledge on the pathophysiology, diagnosis, and treatment of herpes simplex virus keratitis and presents the authors’ own experience with the broad spectrum of clinical manifestations observed in this condition.