Herpes simplex virus stromal keratitis

What it is

From: Orphanet

Herpes simplex (HSV) stromal keratitis is an infectious ocular disease of either necrotizing or non-necrotizing form, due to an HSV infection, and characterized by corneal stromal necrosis, inflammation, ulceration and infiltration by leukocytes. Corneal perforation and blindness can also occur in severe cases.

Reported clinical features and what the terms mean

The following findings are associated with this condition in Orphanet. They are not a checklist for diagnosing yourself, and they do not all occur in every affected person. Some are examination, imaging or laboratory findings that cannot be recognised at home.

The frequency labels describe how often a finding was reported among people with the condition in the source. They do not give the chance that a person with that symptom has the condition. Definitions below reproduce HPO terminology; they explain the term, not the likely severity in an individual.

Corneal stromal edema · Very frequent (99-80%)

Abnormal accumulation of fluid and swelling of the stroma of cornea.

Deep anterior chamber · Very frequent (99-80%)

Increased depth of the anterior chamber, i.e., the anteroposterior distance between the cornea and the iris is increased.

Open angle glaucoma · Very frequent (99-80%)

A type of glaucoma defined by an open, normal appearing anterior chamber angle and raised intraocular pressure,

Reduced visual acuity · Very frequent (99-80%)

Blurred vision · Frequent (79-30%)

Lack of sharpness of vision resulting in the inability to see fine detail.

Conjunctival hyperemia · Frequent (79-30%)

Dilatation of the blood vessels of the conjunctiva leading to a red appearance of the sclera.

Corneal perforation · Frequent (79-30%)

A rupture of the cornea through which a portion of the iris protrudes.

Decreased corneal sensation · Frequent (79-30%)

Reduced ability of the cornea to respond to stimulation.

Descemet Membrane Folds · Frequent (79-30%)

Presence of folds in the Descemet membrane, which is the basement membrane of the endothelial (inner) cell layer of the cornea. Descemet membrane folds are generally a manifestation of inflammation or edema of the cornea.

Epiphora · Frequent (79-30%)

Abnormally increased lacrimation, that is, excessive tearing (watering eye).

Herpetiform corneal ulceration · Frequent (79-30%)

The presence of one or more dendritic corneal epithelial ulcers characterized by a treelike branching linear pattern with feathery edges and terminal bulbs. Herpetiform corneal ulcers can be identified by fluorescein staining.

Herpetiform vesicles · Frequent (79-30%)

Multiple vesicles distributed in multiple distinct groups consisting of multiple adjacent vesicles.

Ocular hypertension · Frequent (79-30%)

Intraocular pressure that is 2 standard deviations above the population mean.

Blindness · Occasional (29-5%)

Blindness is the condition of lacking visual perception defined as a profound reduction in visual perception. On the 6m visual acuity scale, blindness is defined as less than 3/60. On the 20ft visual acuity scale, blindness is defined as less than 20/400. On the decimal visual acuity scale, blindness is defined as less than 0.05. Blindness is typically characterized by a visual field of no greater than 10 degrees in radius around central fixation.

Other findings in the same source

From: Orphanet

Additional reported features include Keratitis (Occasional (29-5%)); Low-grade fever (Occasional (29-5%)); Malaise (Occasional (29-5%)). This is a selected summary, not a complete description of the condition.

When it may begin

From: Orphanet

All ages

Inheritance in the source

From: Orphanet

Not applicable

Frequency and the population described

From: Orphanet

Point prevalence: 1-9 / 100 000; Worldwide; Value and class. Annual incidence: 1-9 / 100 000; France; Value and class.

Which doctor should you see?

The suggested department for discussing Herpes simplex virus stromal keratitis is Ophthalmology, with a ophthalmologist as the relevant type of clinician. Ophthalmologist; paediatric services for children as appropriate.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Which part of the eye or visual pathway is affected?
• What change in vision requires immediate contact with the eye service?
• What are the aims and alternatives of any proposed eye treatment?

Treatment discussions and follow-up

The material gathered for this draft does not provide a complete condition-specific treatment pathway for Herpes simplex virus stromal keratitis. That gap does not mean that treatment is unavailable. A clinician needs to establish the diagnosis and review current guidance before recommending medicines, procedures, rehabilitation or other support.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.