Herpetic Keratitis: A Comprehensive Overview for General Practitioners

Abstract

Herpetic keratitis, predominantly caused by herpes simplex virus type 1 (hsv-1), is one of the leading causes of visual morbidity worldwide. The herpes simplex virus (hsv) has two main serotypes: hsv-1, responsible for ocular pathologies and oral lesions located above the waist, and hsv-2, associated with sexually transmitted diseases, such as recurrent genital lesions, neonatal infections, and increased risk of hiv transmission. hsv-1 infection is a major cause of keratitis, characterized by manifestations such as herpetic dendrites, geographic ulcers, and disciform keratitis, as well as serious complications including blindness. Epidemiologically, hsv-1 affects 67 % of the world’s population before the age of 50, while hsv-2 reaches a prevalence of 11.3 %. Latin America and the Caribbean have a high seroprevalence, with 1 in 5 adults being chronic carriers of hsv-2, reflecting one of the highest rates worldwide. The pathophysiology of keratitis caused by hsv-1 involves viral replication, immune damage to corneal tissue, and recurrent reactivation of the virus, which can be induced by factors such as stress or immunosuppression. This virus first evades the innate immune response, which facilitates its replication in epithelial cells and its latency in the trigeminal ganglion, from where it can reactivate. The adaptive response, mediated by cd8+ and cd4+ T cells, regulates the infection, but viral damage can cause dendritic lesions that progress to stromal ulcers, scarring, neovascularization, and vision loss. Diagnosis requires a detailed medical record, a comprehensive physical examination, and, in complex cases, molecular tests such as polymerase chain reaction. Treatment includes topical and systemic antivirals, such as acyclovir or ganciclovir, and, in specific cases, the controlled use of topical corticosteroids under strict ophthalmological supervision, always accompanied by antiviral therapy.