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Stromal Herpetic Keratitis in the eye – from a cold sore?

Yes, it’s possible that something as relatively insignificant as a […]

By Published On: 11 May 20122.7 min read

Yes, it’s possible that something as relatively insignificant as a cold sore, which you have intermittently over the years, could lead to a Stromal Keratitis in your eye that could potentially scar your cornea with consequential loss of vision.

But relax, the chances of that happening are quite rare, and in any case timely consultation with your optometrist will prevent the worse from happening.

So how does Stromal Herpetic Keratitis in the eye occur?

The simplex Herpes Virus (referred to as HSV) comes in two types, both of which can transmit infection to the eye.

Type 1 HSV is the herpes that occurs on the lips that affects millions of people each year and erupts into cold sore blisters. They normally do not need any particular medical attention, although there are proprietary treatments to prevent them from happening once they are detected.

Type 2 HSV affects the genital area and associated eye infection is rare.

A note on cold sores

Proprietary treatments are no more than remedies in the main, and it has been pointed out by the dental profession (dentists obviously see quite a few) that if a cube of ice straight from the freezer is held hard on the place where the tingling sensation of a forming cold sore is, and for as long as the pain can be endured, it will effectively stop it developing!

Why don’t you try it next time?

Who gets stromal herpetic keratitis?

Stromal keratitis occurs in people who have had type 1 HSV – it may have been dormant for years – and the immune response is low. When a new bout occurs it may be that this time it might just START in the eye.

Alternatively it can be transmitted during a cold sore outbreak by touching (so oral to eye hygiene is of paramount importance!)

The stroma part of the eye is a deeper middle layer of the corneal layer, and so any inflammation from a keratitis can be quite serious without effective treatment.


Treatment of stromal keratitis is similar to that for epithelial keratitis (which affects the outermost layer of the cornea) except that some steroid eye drops may be prescribed in addition to the antiviral ointment and eye drops to further reduce inflammation.

With stromal keratitis it is important to closely supervise the use of the steroids in terms of frequency and strength as they can have adverse effects on treatment and recovery.

What to look for next time

Any herpes related disease is more than likely to reoccur. These reoccurrences may be anything from many months to years.

If the reoccurrences become frequent (and increasingly annoying) then your eye-care specialist might prescribe a regime of regular medication to alleviate the problem. Anecdotal evidence suggests that reoccurrences can be delayed for twice as long by taking an oral anti-viral called Acyclovir.

It should be remembered that frequent infections will gradually increase corneal scarring to the extent that vision loss will be the result, so some attention to frequency is required.

Can anything be done?


Stay out of strong sunlight, or otherwise wear wrap around sunglasses, and avoid stress. Even if these continued actions don’t actually do anything, they won’t do any harm and is practical advice in terms of lifestyle.


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