Herpes viruses cause different illnesses which can affect several parts of the body. In this article I will tell you about one of the most dangerous illnesses that these viruses can cause: keratitis. In this article I also analyze the herpes simplex keratitis treatment.
The prevention of this illness depends on the group of risk you belong. In the article you will be able to know the different groups of risk and with the information that I offer, you will be able to determine to which of these groups you correspond.
If you have suffered from herpes simplex keratitis or you have never suffered from it, but you are seropositive for some of the herpes simplex viruses, in this article you will be able to know a preventive treatment which will avoid that you suffer from keratitis because it eliminates the virus in less than 60 days.
This treatment is the result of the researcher of a British doctor and it has been published in a book that is available in English and Spanish.
Cornea: part of the eye affected by the keratitis [↑]
Cornea is one of the tissues of the human body that doesn’t have blood irrigation, it is transparent and it is located in the front part of the eye allowing the entrance of light.
Human cornea has a fixed bend and, besides protecting the iris and the crystalline lens, it possesses properties that allow the necessary refraction of the light for proper vision.
This important part of the eye is constituted by three layers separated by two membranes. The most external layer is the corneal epithelium, the intermediate layer is the stroma and the most internal layer is the endothelium.
Endothelium is the thickest layer of the cornea and the stroma is of the thinnest corneal layer.
The membrane that separates the corneal epithelium from the stroma is the Membrane of Descemet. Its name proceeds from the name of the doctor and French anatomist Jean Descemet (1732 -1810); it has an acellular structure, its thickness oscillates from 10 to 15 microns, it is usually very resistant to the ulcerations of the cornea and it is composed of fibers of collagen.
The membrane that separates the stroma of the endothelium is the Membrane of Bowman. Its name proceeds from the name of the English oculist William Bowman (1816 -1892) that discovered it. Its thickness varies between eight and 14 microns, it is constituted of fibers of collagen and one of its functions is to maintain the form of the cornea.
Herpes keratitis an eye infection [↑]
Keratitis is a disease of the eye that involves inflammation of the cornea due to small lesions scattered across its surface, an ulcer or other causes that damage this important part of the eye; it usually causes intense ocular pain, photophobia, irritation of the pole previous of the eye and secretion of tears.
Keratitis caused by virus of the first two types is named herpes simplex keratitis or herpes simplex virus keratitis and keratitis due to varicella zoster virus is named varicella zoster keratitis.
Herpes simplex keratitis
Herpes simplex keratitis is caused fundamentally by the herpes simplex virus type 1, which affects the superior part of the body more often, especially the mouth, the nose and the eyes.
This disease can affect a single eye or both, although it affects a single eye in the most common cases. When keratitis affects a single eye it is named unilateral keratitis, when it affects both eyes, it is named bilateral keratitis.
The unilateral keratitis is classified according to the anatomical localization of the corneal affected layer. According to this approach there are three herpes simplex keratitis classes: 1) epithelial keratitis, 2) stromal keratitis and 3) endothelial keratitis.
The herpes simplex epithelial keratitis is caused by the direct infection of the cells of the corneal epithelium, while the herpes simplex stromal keratitis is attributed to a response of the immune system.
Stromal keratitis can appear in two forms: with ulceration of the epithelium or without ulceration of this layer of the cornea.
Herpes simplex endothelial keratitis is relatively not very common and it usually appears independently of the other two types of keratitis. Historically this disease has been named herpes disciform keratitis, although this denomination is commonly used also for a type of herpes simplex stromal keratitis.
The first infection of herpes simplex keratitis is named primary infection. The following infections are named recurrences and in such cases we say patient has history of herpes simplex keratitis.
Herpes zoster keratitis
Herpes zoster keratitis is caused by varicella zoster virus when virus affects us in shingles form. The number of cases of herpes zoster keratitis is much smaller that the number of cases of herpes simplex keratitis.
When the face is affected by the herpes zoster it is probable that the eyes are affected. According to the statistics, approximately 50% of people that suffer from herpes zoster also are affected by herpes keratitis.
Ophthalmic herpes zoster can cause scars in the cornea, inflammation of the uvea (uveitis) and to increase of the intraocular pressure (glaucoma).
The following video contains useful information about herpes zoster ophthalmicus.
Difference between herpes zoster ophthalmicus and herpes simplex keratitis
There are people who ask about differences between herpes zoster ophthalmicus and herpes simplex keratitis.
There are two fundamental differences which are the following:
- The cause of herpes zoster ophthalmicus is varicella-zoster virus, while the cause of herpes simplex keratitis is the herpes simplex virus, fundamentally herpes simplex virus type 1.
- The phrase “herpes zoster ophthalmicus” refers to a variety of diseases of the eye caused by the herpes zoster virus. This variety includes keratitis that is a disease of the cornea, but also includes other diseases such as glaucoma. The phrase “herpes simplex keratitis” refers only to a specific disease: keratitis.
Herpes keratitis causes [↑]
The cause of herpes keratitis is a virus. In most cases the cause of this disease is herpes simplex virus type 1 (HSV-1); although also herpes simplex virus type 2 (HSV-2), associated to genital herpes, and varicella zoster virus, associated to chicken pox and herpes zoster, can cause herpes keratitis.
Herpes simplex viruses are transmitted from person to person through contact with the area affected by an outbreak. For example, if a person that suffers from labial herpes kisses another person is very likely that this person has been infected with herpes virus and after approximately ten days he or she will suffer from labial herpes or herpes in the eyes and therefore from herpes keratitis.
After a person is seropositive for herpes virus she or he is in danger of suffering from herpes keratitis, if herpes are manifested in the eyes. In this situation the patient should consult a doctor for the diagnosis and treatment of the illness.
Is herpes keratitis contagious? [↑]
Herpes keratitis is a viral illness. For this reason, this keratitis is not contagious, but the virus that causes it can cause other illnesses.
If a patient suffers from herpetic keratitis there is high probability herpes virus is present in ocular lesions. If the liquid of these lesions has contact with another person or with other areas of the patient’s body, it is likely the virus will be transmitted.
After the virus has invaded its new host’s tissues, he or she can suffer from keratitis or any other of the illnesses associated to the virus.
On the other hand, if a healthy person gets infected with herpes simplex virus, this person has the possibility of suffering from keratitis even if the person that transmitted the virus had keratitis.
This is the explanation of the herpes keratitis transmission and the answer to the questions about how is herpes keratitis transmitted and how is herpes keratitis contracted.
Factors that propitiate the primary infection or herpes keratitis recurrence [↑]
There are inherited and acquired factors that increase the risks, which are described next according to people’s groups.
First group of risk: people with conditions that suppress the immune system
In this group are included organ transplant recipients, patients with long-standing diabetes mellitus, patients with acute measles infection and seropositive people for HIV virus.
Organ transplant recipients are treated with immune suppressant medicines that usually cause the decrease of the immune response. In carried out studies it has been determined the primary infection and herpes simplex keratitis recurrence are associated to the suppression of the immune system after an organ transplant in patients infected by the virus before the transplant.
The immune response of the patients who suffer from diabetes mellitus for a lot of time weakens. If a patient that has this condition is seropositive for the herpes simplex virus type 1, it is probable she or he will suffer from herpes simplex keratitis. In studies carried out in Israel it was proven herpes keratitis is more common in patient with diabetes mellitus that in patient without diabetes.
Measles weakens the immune response of the body. For this reason, patients that suffer from a severe measles infection and are seropositive for herpes simplex virus, have risk of suffering from herpes simplex keratitis. In carried out epidemiologic studies it has been proven this statement.
In studies carried out in patients infected by the HIV virus it was proven the infection rate with herpes simplex epithelial keratitis was bigger than in the patients without this condition. It was also proven the treatment with antiviral agents should be more lingering in seropositive patients for HIV virus that in not infected patients.
Second group of risk: people affected by factors that alter or stress the immune system
Comparative studies about the affectations of the herpes simplex keratitis in children and adults have revealed the bilateral keratitis has a bigger prevalence in children. In a same way the children are more prone than the adults to suffer from epithelial keratitis and stromal keratitis simultaneously.
The inflammatory response to the stromal keratitis is more severe in children than in adults. It causes ulceration of the stroma.
Atopic persons have personal or family antecedents of development of an antibody named atopic reagin which usually causes immediate allergic reactions such as asthma, dermatitis and inflammation of the nasal fossas (rhinitis) in response to the contact with substances and objects (perfumes, wool, animals and others) that are innocuous for the general population.
Atopic patients are more susceptible to herpes simplex virus and keratitis caused by it.
In studies carried out in California about affectations of herpes simplex keratitis in atopic and non-atopic patients it was proven bilateral keratitis has bigger prevalence in atopic patients that in persons who don’t have this condition. It was also proven the response of these individuals to the treatment with antiviral agents is more delayed.
Third group of risk: people with susceptible cornea
Herpes keratitis is an infection of the cornea which can be more susceptible under certain conditions.
Topical ocular hypotensive agents and corticosteroids cause susceptibility of the cornea to the infection by herpes simplex virus. It has been proven the primary infection and recurrence of herpes keratitis are associated to the topical treatment with hypotensive agents in patients that were seropositive for herpes simplex virus before beginning the treatment.
Corticosteroids are substances used to attenuate the response of the tissue to the inflammatory processes, but without treating the subjacent cause. These substances affect several aspects of the immune response and they should not be used without medical prescription because their use is risky for the health.
The use of corticosteroids can cause primary infection or recurrence of herpes keratitis in patient seropositive for herpes simplex virus. Therapy with corticosteroids is usually used for the treatment of herpes simplex stromal keratitis. In carried out studies it has been proven that epithelial keratitis is associated to this therapy, that is to say, a part of the patients have developed epithelial keratitis along with the stromal keratitis that they suffered when beginning the treatment.
The use of contact lens, ocular surgeries with laser and other ocular surgeries are included under the conditions that cause ocular trauma.
Although the use of contact lens can cause ocular trauma, in the carried out studies there has not been association between the primary herpes keratitis infection or its recurrence and the use of contact lens.
Studies carried out in patients subjected to surgery with laser have reported primary infection or herpes simplex keratitis recurrence after the intervention.
Any surgery of the eye increases the possibility to contract herpes keratitis in seropositive patient. In these cases therapy with antiviral agents is recommended while the patient is under treatment with corticosteroids.
Herpes keratitis prevention [↑]
We should analyze the herpes keratitis prophylaxis according to the following groups of cases:
Group 1: formed by all persons who are not seropositive for herpes simplex virus.
Group 2: formed by all persons who are seropositive for herpes simplex virus without suffering from any illness caused by it.
Group 3: constituted by all patients who have suffered from some illness caused by the virus, but not in the eyes.
Group 4: constituted by all persons with history of herpes simplex keratitis
Herpes simplex keratitis prevention in the individuals of the group 1 is based on avoiding the infection with the viruses by means of hygienic-sanitary measures because at the present time there is not a vaccine that immunizes against them.
The individuals of the groups 1 and 2 are difficult to differ in the practice because seropositive people that have not been affected don’t usually know that they are seropositive.
Any person that has been exposed to herpes virus should visit their doctor who could indicate a diagnosis test with the purpose of checking if the infection is present.
The individuals of the groups 2, 3 and 4 that are not affected by any of the factors of risk can prevent the herpes simplex keratitis using “The Ultimate Herpes Protocol” which is able to eliminate the virus of their bodies in less than 60 days.
This protocol relies on the use of natural and traditional medicine to fight the virus in three phases. The first phase is designed to strengthen your immune system; in the second phase the protective layer of protein of the virus is eliminated and the third phase actions are undertaken to prevent the replication of the virus.
The first phase of this protocol is about alimentation. If you want to avoid the ideal conditions for the manifestation of the virus you should eat properly and follow a healthy lifestyle.
We should consume foods, rich in lysine and poor in arginine, to avoid the consumption of molded food and to sleep at least eight hours a day.
Keratitis herpes prevention in the individuals of the group 4 affected by factors of risk are the most difficult although these patients are those that have the biggest probability of suffering from keratitis.
Herpes simplex keratitis treatment with medications [↑]
If you suffer from herpes simplex keratitis, you will be interested in knowing the answers to the following questions:
Is herpes simplex keratitis curable?
Can herpes keratitis be cured?
These questions have an affirmative answer, if you are treated by a doctor.
Herpes simplex keratitis treatment with medications depends on the type of keratitis and the patient’s conditions.
First three medications (1, 2 and 3) are no longer manufactured and the use of 4, 5 and 6 are limited by a poor safety profile. Two of them (7 and 8) have topic use and the three remaining (9, 10 and 11) are systemic medication.
Systemic antiviral agents (acyclovir, valacyclovir and famciclovir) are available in presentations for their consumption for oral way, intravenous and topic way, but Food and Drug Administration (FDA) of the United States of America has not approved the topical acyclovir as an ophthalmic antiviral agent.
Treatment for herpes simplex epithelial keratitis
Herpes simplex epithelial keratitis can be treated with topical antiviral agents or for oral way. There is no evidence the simultaneous use of two antiviral agents accelerates the cure of the illness.
It is recommended the topical treatment of this illness be based on the use of ganciclovir gel (0.15%) or trifluridine solution (1%). The oculist determines the dose to use and the duration of the treatment according to the patient’s conditions and of the type of epithelial keratitis (dendritic or geographic).
There are not comparative studies about the effectiveness of the ganciclovir gel and the trifluridine drops in the treatment of herpes simplex epithelial keratitis. Available studies compare the effectiveness of each one of these medications with the effectiveness of the acyclovir ointment.
Treatment for epithelial herpes simplex keratitis for oral way using systemic antiviral agents (acyclovir, valacyclovir or famciclovir) is as effective as the use of the ganciclovir gel or trifluridine drops, but these medications are contraindicated in pregnant women and should be used with caution in 65 year-old people and in patient with renal impairment.
It is recommended not to use corticosteroids in the treatment of herpes simplex epithelial keratitis because its use can facilitate the action of the virus instead of stopping it.
Treatment for herpes simplex stromal keratitis
The treatment of herpes simplex stromal keratitis should involve antiviral agents and topical corticosteroids.
For the treatment of this type of keratitis it is recommended the use of an oral antiviral agent along with a topical corticosteroid. The balance of the doses of both types of medications depends on if there is epithelial ulceration or not and on the patient’s conditions.
Corticosteroid has a therapeutic function and the antiviral agent has a prophylactic purpose in the treatment of the stromal keratitis without ulceration of the epithelium. When there is ulceration of the epithelium, the antiviral agent has a therapeutic utility and the dose of the corticosteroid is limited.
In these cases the use of topical antiviral agents (ganciclovir and trifluridine) is not recommended. The lingering use of the trifluridine drops causes keratoconjunctivitis, allergic conjunctivitis and punctual stenosis.
Treatment for herpes simplex endothelial keratitis
Treatment for herpes simplex endothelial keratitis should include the use of corticosteroids in conjunction with oral antiviral agent. The use of the topical antiviral agents (ganciclovir and trifluridine) is not recommended in these cases.
The treatment of endothelial herpes is less lingering than in patients that suffer from stromal keratitis.
Summary of herpes simplex keratitis treatment with medications
Herpes keratitis duration depends on several factors among them: 1) affected layer of the cornea, 2) applied treatment and 3) response of the patient to the treatment.
Stromal keratitis is usually he one that lasts longer; its cure can take more than 70 days. The cure of the endothelial keratitis can take between 25 and 30 days. The cure of the endothelium keratitis with dendritic ulcer can take up to 21 days.
|Table 1: Summary of herpes simplex keratitis treatment|
|Type of keratitis||Antiviral agent||Corticosteroid|
|Epithelial keratitis||Oral antiviral agent (acyclovir, valacyclovir or famciclovir) or topical antiviral agent (trifluridine or ganciclovir).|
|Stromal keratitis without epithelium ulceration||Oral antiviral agent with prophylactic function.||Topical corticosteroid with therapeutic function.|
|Stromal keratitis with epithelium ulceration||Oral antiviral agent with therapeutic function.||Limited dose of topical corticosteroid.|
|Endothelial keratitis||Oral antiviral agent with therapeutic function.||Topical corticosteroid with therapeutic function.|
Does herpes keratitis go away?
Medications don’t eliminate the virus of the body neither they avoid that it is transmitted. It is for that reason that while we suffer from herpes keratitis we should be careful when being related with other people.
Systemic antiviral agents don’t avoid us to suffer several times of herpetic keratitis because the virus remains latent in our body and when the suitable conditions take place, it can cause us a recurrence of the illness.
Treatment with medications cures herpes keratitis, but it doesn’t avoid its recurrence. For this reason, it is recommended after the cure you use a preventive treatment as The Ultimate Herpes Protocol in order to kill herpes virus from your body.
Final notes about herpes simplex keratitis treatment
Cornea is a delicate tissue of the eye and keratitis is an illness that affects it being able to cause the decrease or loss of the vision.
Herpes simplex virus type 1 is one of the fundamental causes of keratitis. There is not a vaccine to fight it, but you can eliminate it in less than 60 days with “The Ultimate Herpes Protocol”.
If you have been infected with the virus and you want to avoid herpes keratitis you can begin the treatment today with “The Ultimate Herpes Protocol”.
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Complementary sources of information:
http://www.fda.gov (U.S. Food & Drug).