Ocular Herpes Simplex Virus Infections and Management

Ocular herpes simplex virus (HSV) infection is a global public health concern and a leading cause of infectious blindness. HSV type 1 predominantly affects the eye, establishing latency in the trigeminal ganglion and giving rise to recurrent disease. Primary infection may present as blepharitis or conjunctivitis, but the most sight-threatening manifestation is keratitis, which can involve the corneal epithelium, stroma or endothelium. Recurrent stromal keratitis provokes immune-mediated inflammation, scarring and neovascularisation, with cumulative damage over successive episodes. Clinical diagnosis relies on slit-lamp biomicroscopy, often supported by polymerase chain reaction to detect viral DNA. Standard management encompasses topical and systemic nucleoside analogues such as aciclovir, combined judiciously with corticosteroids to control stromal inflammation. Adjunctive strategies under investigation include calcineurin inhibitors, interferons and novel antiviral agents able to target latent reservoirs. Surgical interventions—ranging from amniotic membrane transplantation to penetrating keratoplasty—address corneal thinning and scarring but carry risks of graft failure, particularly in eyes harbouring residual virus. Despite effective suppression of acute episodes, HSV cannot yet be eradicated from the host. Continued efforts to define host and environmental risk factors, improve diagnostic precision and develop prophylactic or therapeutic vaccines remain critical to reducing the burden of herpetic eye disease worldwide.

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Ocular Herpes Simplex Virus Infections and Management publication trend

The graph below shows the total number of articles in ocular herpes simplex virus infections and management across all publications each year (not limited to Nature Index journals).

Technical terms

Herpes simplex keratitis: Corneal infection caused by HSV, manifesting as dendritic epithelial lesions or stromal inflammation and scarring.

Dendritic keratitis: Branching epithelial ulceration of the cornea characteristic of HSV recurrence.

Polymerase chain reaction (PCR): Molecular technique used to amplify and detect viral DNA in ocular samples for precise diagnosis.

Stromal keratitis: Immune-mediated inflammation of the corneal stroma in HSV infection, leading to scarring and vascularisation.

Calcineurin inhibitor: Immunosuppressive agent (e.g. tacrolimus) that modulates T-cell activation and may reduce corneal inflammation.

References

1. Sociodemographic factors and comorbidities are associated with an elevated risk of herpes simplex keratitis: a population-based study in Taiwan. Frontiers in Microbiology (2024).
2. Atopic Disease as a Risk Factor for Recurrent Herpetic Keratitis. Microorganisms (2024).
3. INCIDENCE OF HERPES SIMPLEX VIRUS KERATITIS AND OTHER OCULAR DISEASE: GLOBAL REVIEW AND ESTIMATES. Ophthalmic Epidemiology (2021).
4. Ocular herpes: the pathophysiology, management and treatment of herpetic eye diseases. Virologica Sinica (2014).
5. Clinical Management of Herpes Simplex Virus Keratitis. Diagnostics (2022).
6. Topical Tacrolimus as an adjunct to Conventional Therapy for Stromal Herpetic Keratitis: a Randomized Clinical Trial. Journal of Ophthalmic and Vision Research (2019).
7. A Comparison of the Clinical and Molecular Diagnosis of Herpes Simplex Keratitis. Open Journal of Ophthalmology (2014).
8. The outcome of penetrating keratoplasty for corneal scarring due to herpes simplex keratitis. Arquivos Brasileiros de Oftalmologia (2017).
9. Prevalence of Herpesvirus DNA in Corneal Transplant Recipients. Journal of Clinical Medicine (2022).