Which clinical history findings are characteristic of herpes simplex virus (HSV) keratitis in HIV infection?

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
  • Print


Primary ocular HSV infection often presents as unilateral blepharoconjunctivitis. The conjunctival inflammatory response is frequently follicular, with associated preauricular lymphadenopathy. Cutaneous vesicles on the eyelid skin or margin appear in most of the cases.

Follicular conjunctivitis caused by HSV sometimes may be difficult to distinguish from that caused by adenovirus. Helpful distinguishing features include the characteristic dendritic morphology of HSV keratitis, presence of cutaneous vesicles, absence of an associated epidemic, and the predominant unilaterality (approximately 10% of HSV keratitis cases are bilateral, whereas most of the adenovirus keratoconjunctivitis cases are bilateral).

Patients with dendritic epithelial keratitis may have no obvious symptoms, or they may complain of foreign-body sensation, photophobia, redness, and blurred vision.

Recurrent HSV epithelial keratitis usually manifests as characteristic dendritic branching. The lesions may start as distinct punctate epithelial keratitis, which then coalesce into dendritic-shaped lesions composed of swollen opaque epithelial cells within days.

The dendritic terminals have a peculiar bulblike morphology. A narrow epithelial defect often develops in the center of the dendrite within days of onset, usually as a result of lysis of virus-infected cells. The opaque cells around the central ulcer stain well with rose bengal and fairly well with fluorescein. The predisposing factors for developing geographic ulcers include the HSV strain, topical or systemic immunosuppressive therapy, and HIV infection.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!