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Herpetic keratitis: diagnosis and treatment
Last reviewed: 07.07.2025
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Diagnosis of herpetic keratitis
Diagnosis of herpetic keratitis is based mainly on the typical clinical picture of the disease. Some characteristic signs are detected already at the onset of the disease, for example, vesicular, tree-like rashes, decreased sensitivity, association with colds and herpetic inflammation foci on other parts of the body. Some features of the clinical picture appear too late: absence of neovascularization for a long period of time, protracted course of the inflammatory process, tendency to relapse. In this regard, laboratory diagnostic methods are used in case of atypical keratitis. Scrapings of the conjunctival and corneal epithelium, as well as lacrimal fluid are taken for the study. The most informative and rapid method is the detection of fluorescent antibodies. An intradermal test with an antiherpetic vaccine is performed only at the initial encounter with the virus. A focal allergic test with an antiherpetic vaccine is an important method of etiological diagnosis in atypical cases. This provocative test is considered positive if, in response to intradermal administration of the vaccine in weak dilutions, an exacerbation of the inflammatory process occurs, pain and pericorneal injection of vessels increase, and fresh precipitates appear. Diagnostic tests are carried out with caution according to strict indications.
[ Treatment of herpetic keratitis
Treatment of herpetic keratitis is complex and long-term. It is aimed at suppressing the activity of the virus, improving trophic processes in the cornea, accelerating the epithelialization of defects, and increasing local and general immunity.
Antiviral treatment includes chemotherapy, non-specific and specific immunotherapy. At different stages of the disease, appropriate combinations of drugs are used. At the onset of the disease, frequent daily instillation of kerecide, deoxyribonuclease, ointments with tebrofen, florenal, bonafton, oxolin, zovirax are applied 3-4 times a day. Every 5-10 days, the drugs are changed. Acyclovir is taken orally for 10 days. If the eye disease is combined with herpetic inflammation of another localization, the duration of the course of treatment is increased to 1-2 months. In case of severe complications, intravenous infusions of acyclovir are administered every 8 hours for 3-5 days. This is a highly active drug, but has a narrow spectrum of action, so it is used against the herpes simplex and herpes zoster viruses.
Along with chemotherapy, non-specific antiviral agents are used - interferon in drops and subconjunctivally, as well as drugs that stimulate the production of endogenous interferon (interferonogens), preventing the reproduction of the virus in the cell - poludan (course dose - 2000 U), pyrogenal in apyrogenic doses, prodigiosan (3-5 intramuscular injections). With reduced immunity, chronic and recurrent course of the disease, immunostimulants are prescribed - levamisole, thymalin. For specific immunotherapy, human immunoglobulin and antiherpetic vaccine are used.
For the treatment of various forms of keratitis, optimal combinations of antiviral agents and regimens for their use have been developed.
To cleanse ulcer surfaces from necrotic masses, a cryoprobe or laser coagulation is used. In cases of long-term non-healing herpetic keratitis, a corneal transplant is performed for therapeutic purposes.
In cases where bacterial flora joins in, sulfanilamide preparations, antibiotics, non-steroidal anti-inflammatory drugs in the form of drops and ointments are additionally prescribed. Mydriatics are used to prevent and treat concomitant iritis and iridocyclitis.
In addition to the main antiviral treatment, vitamins and drugs that improve corneal trophism are prescribed, as well as antiallergic drugs, if necessary.
Corticosteroid drugs are used with great caution only in the regression stage of deep stromal keratitis, under constant monitoring of the state of the corneal epithelium and intraocular pressure, since they can complicate the course of herpetic keratitis, and in the interictal period contribute to the occurrence of relapses due to the pronounced immunosuppressive effect.
After completion of anti-inflammatory and symptomatic treatment of keratitis, when the eye is completely calm, restorative treatment is required - corneal transplantation for optical purposes.