Infectious epithelial keratitis

Infectious epithelial keratitis is an inflammatory condition of the cornea in which the outermost layer (epithelium) becomes infected by a microbial pathogen. The most common causative agent is herpes simplex virus (HSV), which produces the characteristic dendritic or geographic ulcer pattern on the corneal surface. Other infectious agents, including varicella-zoster virus, adenoviruses, and certain bacteria or fungi, can also cause epithelial keratitis. The disease primarily affects the eye, and patients typically experience eye pain, tearing, photophobia (light sensitivity), foreign body sensation, blurred vision, and conjunctival redness. The corneal epithelium may show punctate or dendritic lesions visible on slit-lamp examination, often highlighted with fluorescein staining. The condition can occur at any age but is more commonly diagnosed in adults. Risk factors include contact lens wear, ocular surface disease, immunosuppression, and prior herpetic eye disease. If left untreated or if recurrences are frequent, infectious epithelial keratitis can lead to corneal scarring and permanent visual impairment. Treatment depends on the underlying pathogen. For herpes simplex epithelial keratitis, topical antiviral agents such as acyclovir ointment, ganciclovir gel, or trifluridine drops are the mainstay of therapy and are generally effective in resolving the acute infection. Oral antiviral prophylaxis (e.g., oral acyclovir or valacyclovir) may be used to reduce recurrence rates. Bacterial causes require appropriate topical antibiotic therapy. Importantly, topical corticosteroids are generally contraindicated in active epithelial keratitis as they can worsen the infection and promote deeper corneal involvement. Early diagnosis and prompt treatment are essential to preserve vision and prevent complications such as stromal keratitis or corneal perforation.

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