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Keratitis – Cold sore of the eye

I saw a patient today who kept on getting an irritation of his right eye with a little white area close to what is called the limbus. The limbus is the junction of the cornea and the white of the eye.
On examination, he had a corneal epithelial disturbance, a keratitis, with some blood vessels leading to it. It was a typical viral herpes simplex keratitis. In other words, a cold sore of the eye which would re-active intermittently.
The herpes simplex virus can live in the nerves and cause a cold sore frequently around the mouth. Occasionally, it can also cause the equivalent of a cold sore in the eye, called a dendritic ulcer or HSV keratitis. Like a cold sore around the mouth, it will recur from time to time and require urgent review with an ophthalmologist when it is active. The most likely treatment is going to be Ganciclovir ointment five times a day for five days and possibly even oral Acyclovir. If there is a lot of infiltrate, I may have to use a little bit of steroid and monitor it very carefully.
It is always a shock for a patient to hear they might have a herpes virus. This does not mean that they are highly infectious. It is not genital herpes, although genital herpes also is like a cold sore. This particular “eye” cold sore or “dendritic ulcer” cannot be easily spread to another. It is just a reactivation of the dormant virus living in the nerve, and it reactivates when the patient is under stress, exposed to a lot of ultraviolet light or just occasionally when it feels like it.
Once it is better, it may not reactivate for several months or years. Occasionally, it gets worse and causes a small scar. If it is recurrent, it can cause a small scar with some blood vessels leading into it. This can go on to affect the vision if it is not caught early and treated by an ophthalmologist.
For my patient, he had had several small recurrent episodes of redness and irritation, so he already had a faint permanent scar and blood vessels. Now he knows what it is and he knows to go straight to an ophthalmologist whenever it reactivates. This way his vision will likely remain stable.
If you think that you may have an acute dendritic ulcer or HSV keratitis, you should see an ophthalmologist urgently in the Urgent Eye Care Clinic at Clinica London. The signs and symptoms of keratitis include:

  • red eye
  • eye pain
  • excess tears from the eye
  • irritation
  • blurred vision
  • sensitivity to light
  • a feeling that something is in the eye

Any delay in diagnosis and delay in treatment of keratitis could lead to serious complications including vision loss. So if you have any signs or symptoms of keratitis, make sure that you have an appointment to see your ophthalmologist right away.


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