What causes herpes simplex virus (HSV) keratitis?

Updated: Jan 18, 2019
  • Author: Jim C Wang (王崇安), MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Causes of the various manifestations of HSV keratitis include the following:

  • Infectious epithelial keratitis - Results from active viral replication within the corneal epithelium

  • Neurotrophic keratopathy - A poorly understood disease; the cause is thought to be multifactorial

  • Necrotizing stromal keratitis - Arises from direct infection of the corneal stroma and the resultant severe host inflammatory response ; the use of topical corticosteroids without antiviral coverage may be a possible risk factor for its development

  • Immune stromal keratitis - An antibody-complement cascade triggered by retained viral antigen or altered host antigen within the stroma

  • Endotheliitis - Believed to be primarily an immunologic reaction to an antigen in endothelial cells; however, the role of live virus has been speculated

Neurotrophic keratopathy develops in patients with previous HSV epithelial disease. Traditionally thought of as neither infectious nor immunologic in origin, neurotrophic keratopathy arises from impaired corneal innervation and decreased tear formation (as a result of prior HSV infection of the sensory nerves), exacerbated by long-term use of topical medications, especially antiviral agents. However, evidence suggests that HSV replication may occur in persistent epithelial defects.

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