Herpes Simplex Virus Stromal Keratitis

Herpes Simplex Virus Stromal Keratitis (often shortened to HSV Stromal Keratitis) is a serious infection of the corneal stroma—the thick, transparent middle layer of the clear front surface of your eye (the cornea). In this condition, the herpes simplex virus (HSV)—the same virus that can cause cold sores around the mouth—reaches the corneal stroma and causes inflammation, scarring, and sometimes vision loss. In very simple terms, HSV Stromal Keratitis means “HSV infection deep inside the clear window at the front of the eye,” where stromal means the tissue layer below the surface and keratitis means inflammation of the cornea.

Because the corneal stroma gives the eye its clarity and shape, any swelling, inflammation, or scarring here can blur vision or even leave permanent scars. HSV can lie dormant (inactive) in nerve cells around the eye and reactivate later, causing repeated bouts of inflammation. If not treated quickly and properly, these repeat infections may thin the cornea, lead to ulcers, or allow harmful bacteria to grow, threatening vision.

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Types of HSV Stromal Keratitis

There are three main types of stromal keratitis caused by HSV. Each type affects the cornea differently:

1. Immune (Non-Necrotizing) Stromal Keratitis

   • Here, the virus itself may no longer be alive in the stroma. Instead, the body’s own immune cells (white blood cells) attack parts of the cornea where viral proteins are still present. This causes swelling and haze but not actual tissue death.

2. Necrotizing Stromal Keratitis

   • In this type, active virus directly damages and kills (necrosis means cell death) corneal tissue. You see white, melting areas in the stroma that can lead to thinning and even holes in the cornea if severe.

3. Disciform Keratitis

   • “Disciform” means “disc-shaped.” In this form, fluid builds up in a round shape in the central stroma, causing a disc-shaped area of swelling. It’s thought to be partly immune-driven but can also have low levels of active virus.

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Causes and Risk Factors

Although HSV Stromal Keratitis is triggered by the herpes simplex virus, various factors make it more likely to occur or recur. Here are 20 common causes and triggers, each explained in plain English:

1. Primary HSV Infection

   • The first time you catch HSV (often around the mouth or eye), the virus can travel to the cornea and set up a hidden infection in nearby nerves.

2. Reactivation of Latent Virus

   • HSV can hide in nerve cells without causing symptoms. Later, it can wake up and travel back to the cornea, sparking inflammation.

3. Stress

   • Physical or emotional stress can weaken immune defenses, making it easier for the virus to reactivate.

4. Fever (“Fever Blisters”)

   • A high temperature or other illness can trigger virus reactivation, even without cold sores.

5. Ultraviolet (UV) Light Exposure

   • Strong sunlight, tanning beds, or welding light can irritate the eye and reactivate HSV.

6. Hormonal Changes

   • Fluctuations in hormones (for example during menstruation or pregnancy) can affect immune balance and allow the virus to flare.

7. Ocular Surgery or Trauma

   • Any cut, burn, or surgery on the eye (like cataract surgery) can disturb local nerves and tissues, triggering HSV.

8. Contact Lens Overuse

   • Sleeping or swimming with lenses can scratch the cornea and invite viral activation.

9. Topical Corticosteroid Use

   • Eye drops that reduce inflammation can also suppress local immunity, allowing HSV to grow.

10. Systemic Immunosuppression

• Medicines or conditions that weaken the whole-body immune system (for example chemotherapy or HIV) increase risk.

11. Diabetes Mellitus

• High blood sugar can damage nerves and blood vessels, making HSV reactivation more likely.

12. Nutritional Deficiencies

• Lack of vitamins (especially A, C, and E) and minerals weakens the eye’s natural defenses.

13. Poor Hygiene

• Rubbing eyes with unwashed hands can spread virus from other sites (like cold sores).

14. Environmental Irritants

• Smoke, dust, or chemicals can inflame the ocular surface and trigger HSV.

15. Concurrent Eye Infections

• Having another infection of the eye (bacterial, fungal, or adenovirus) can disturb local immune balance.

16. Allergic Eye Disease

• Chronic eye allergies can cause rubbing and medication use that trigger HSV.

17. Neurotrophic Keratopathy

• When corneal nerves are damaged (from prior HSV or other causes), the cornea cannot sense injury properly, increasing infection risk.

18. Autoimmune Disorders

• Conditions like rheumatoid arthritis or lupus can change immune responses in the eye.

19. Genetic Susceptibility

• Some people naturally have weaker immune defenses against HSV.

20. Previous Herpetic Eye Episodes

• Each past episode slightly increases the chance of future stromal involvement.

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Common Symptoms

Symptoms of HSV Stromal Keratitis often come on suddenly and may include:

1. Eye Redness

   • Blood vessels in the white part of the eye become larger and more visible.

2. Eye Pain

   • Ranges from mild discomfort to sharp or aching pain.

3. Sensitivity to Light (Photophobia)

   • Bright lights hurt the eye and make you want to close your eyelid.

4. Blurry Vision

   • Swelling or scarring in the stroma makes images fuzzy.

5. Tearing (Epiphora)

   • The eye makes extra tears in response to irritation.

6. Foreign-Body Sensation

   • Feels like something is stuck in the eye all the time.

7. Corneal Haze

   • A cloudy patch appears in the clear cornea.

8. Disc-Shaped Swelling

   • In disciform keratitis, you may notice a round, white area.

9. Corneal Scarring

   • Past inflammation can leave whitish scars.

10. Decreased Contrast

• Colors and edges look faded or washed out.

11. Halos Around Lights

• Rings or glows appear around bright lights.

12. Headache

• Often near the forehead or eye socket.

13. Eyelid Swelling or Redness

• Eyelids may puff up or look inflamed.

14. Pupil Irregularity

• The dark center of the eye (pupil) may change shape if inflammation reaches deeper tissues.

15. Glare

• Sunlight or headlights feel uncomfortable when driving at night.

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Diagnostic Tests

Diagnosing HSV Stromal Keratitis involves a mix of physical checks, manual tests, lab work, electrical measurements, and imaging scans. Here are 20 different tests, grouped by type:

1. Physical Exam

1. Visual Acuity Test

   • Measures how well you can see letters on a chart at a distance.

2. External Eye Inspection

   • Looks at eyelids, lashes, and the white of the eye for redness or swelling.

3. Slit-Lamp Biomicroscopy

   • Uses a bright, narrow beam of light and a microscope to examine the cornea in high detail.

4. Pupil Light Reflex

   • Checks if the pupil (dark center) reacts normally to bright light.

2. Manual Tests

5. Corneal Sensitivity Test

   • Touches the cornea gently with a fine nylon filament (Cochet-Bonnet esthesiometer) to see if feeling is reduced.

6. Fluorescein Staining

   • Instils a drop of orange dye (fluorescein) into the eye; damaged areas glow green under blue light.

7. Rose Bengal Staining

   • Uses a pink dye that highlights dead or dying epithelial cells.

8. Lissamine Green Staining

   • Highlights damaged or detached cells, especially useful in immune-mediated keratitis.

3. Lab & Pathological Tests

9. HSV Polymerase Chain Reaction (PCR)

   • Detects tiny amounts of viral DNA from a corneal scraping, confirming active infection.

10. Viral Culture

    • Grows live virus from corneal cells in a lab dish to identify HSV.

11. Direct Immunofluorescence

    • Binds fluorescent antibodies to viral proteins in tissue samples to show where HSV is present.

12. Serologic Testing (ELISA)

    • Measures antibodies against HSV in the blood; suggests past exposure but less specific for eye infection.

4. Electrodiagnostic Tests

13. Electroretinography (ERG)

    • Records electrical responses from the retina; usually normal in stromal keratitis but helps rule out deeper infection.

14. Visual Evoked Potential (VEP)

    • Measures electrical signals from the brain in response to visual stimuli; checks the whole visual pathway if vision loss is severe.

15. Corneal Esthesiometry

    • Measures electrical changes on the cornea when nerve function is tested; confirms nerve damage from HSV.

16. Blink Reflex Test

    • Electrically stimulates the trigeminal nerve to see if eyelid closure is normal; can detect nerve involvement.

5. Imaging Tests

17. Anterior Segment Optical Coherence Tomography (AS-OCT)

    • A non-contact scan that creates detailed, cross-sectional images of the cornea’s layers.

18. In Vivo Confocal Microscopy

    • Uses a high-resolution microscope built into a special lens to view living cells in the cornea directly.

19. Ultrasound Biomicroscopy (UBM)

    • Uses high-frequency ultrasound waves to image deeper structures of the front of the eye.

20. Corneal Topography

    • Maps the corneal surface shape, showing irregularities or thinning from scarring.

Non-Pharmacological Treatments

Supportive, non-drug measures can ease symptoms, protect the eye, and promote healing Wikipedia.

1. Cool Compresses
   Description: A clean cloth soaked in cool water applied gently to the closed eyelid.
   Purpose: Relieves eye pain and swelling.
   Mechanism: Cooling constricts blood vessels, reducing inflammation and numbing pain receptors.

2. Artificial Tears
   Description: Over-the-counter lubricating eye drops or gels.
   Purpose: Keeps the cornea moist to reduce friction and discomfort.
   Mechanism: Supplements natural tears, promoting epithelial healing and flushing out irritants.

3. Moisture Chamber Goggles
   Description: Enclosed eyewear designed to maintain humidity around the eye.
   Purpose: Prevents tear evaporation in severe dry eye associated with stromal disease.
   Mechanism: Traps moisture, creating a stable tear film.

4. Bandage Contact Lens
   Description: Soft, therapeutic contact lens worn temporarily.
   Purpose: Protects a damaged cornea and supports epithelial regeneration.
   Mechanism: Acts as a physical barrier, reducing pain from blinking and promoting healing.

5. Punctal Occlusion
   Description: In-office insertion of tiny plugs into tear ducts.
   Purpose: Keeps tears and artificial tears on the eye surface longer.
   Mechanism: Blocks tear drainage, increasing tear film stability.

6. Amniotic Membrane Transplant
   Description: Placement of a thin, biologic graft over the cornea.
   Purpose: Promotes anti-inflammatory and healing effects in severe cases.
   Mechanism: Releases growth factors and anti-scarring proteins to the cornea.

7. Mechanical Debridement
   Description: Gently scraping away loose or infected epithelial cells under slit-lamp.
   Purpose: Removes virus-laden cells and allows healthy tissue to regenerate.
   Mechanism: Reduces viral load on the corneal surface.

8. Tarsorrhaphy (Partial Eyelid Closure)
   Description: Surgically sewing part of the eyelids together temporarily.
   Purpose: Protects the cornea in severe exposure or non-healing ulcers.
   Mechanism: Reduces surface exposure, maintaining a moist environment.

9. UV-Blocking Sunglasses
   Description: Wraparound sunglasses with UV protection.
   Purpose: Minimizes UV-triggered viral reactivation and photophobia.
   Mechanism: Filters harmful UV rays that can stress the cornea and trigger inflammation.

10. Eyelid Hygiene
    Description: Daily cleaning of eyelid margins with mild solution.
    Purpose: Reduces microbial load that can worsen inflammation.
    Mechanism: Removes debris and bacteria, preventing secondary infections.

11. Rest and Sleep Hygiene
    Description: Ensuring 7–8 hours of sleep nightly.
    Purpose: Supports immune function and tissue repair.
    Mechanism: Hormonal balance during sleep boosts healing processes.

12. Stress Management
    Description: Techniques like deep breathing, meditation, or yoga.
    Purpose: Lowers stress hormones that can trigger HSV reactivation.
    Mechanism: Reduces cortisol levels, which modulate immune responses.

13. Warm Compresses
    Description: A clean cloth soaked in warm water placed on closed eyelid.
    Purpose: Loosens debris in the tear ducts and improves tear quality.
    Mechanism: Heat melts obstructive gland secretions, improving tear film.

14. Good Hand Hygiene
    Description: Frequent handwashing with soap and water.
    Purpose: Prevents transfer of HSV from fingers to eyes.
    Mechanism: Removes virus particles from hands.

15. Face Mask in Dusty Areas
    Description: Wearing a protective mask outdoors.
    Purpose: Prevents airborne irritants from contacting the eye.
    Mechanism: Filters dust and allergens.

16. Humidifier Use
    Description: Running a room humidifier.
    Purpose: Keeps air moist to prevent tear evaporation.
    Mechanism: Increases ambient humidity, aiding the tear film.

17. Photophobia Management
    Description: Dimming lights or using tinted lenses indoors.
    Purpose: Reduces pain from light sensitivity.
    Mechanism: Lowers light intensity reaching inflamed cornea.

18. Balanced Nutrition
    Description: Eating a diet rich in fruits, vegetables, and proteins.
    Purpose: Provides nutrients essential for immune and tissue repair.
    Mechanism: Supplies vitamins and amino acids needed for cell regeneration.

19. Regular Eye Rest
    Description: Taking breaks from screens every 20 minutes.
    Purpose: Reduces eye strain and dryness.
    Mechanism: Encourages blinking and tear spread.

20. Avoiding Contact Lens Wear
    Description: Pausing lens use during active disease.
    Purpose: Prevents additional trauma and infection risk.
    Mechanism: Eliminates foreign-body interaction with a vulnerable cornea.

Drug Treatments

Medical therapy combines antiviral agents to stop replication and corticosteroids to control inflammation EyeWikiPMC.

1. Topical Prednisolone Acetate 1%
   Class: Corticosteroid
   Dosage & Time: One drop every 1–2 hours initially, tapering over 10–12 weeks.
   Purpose: Reduces stromal inflammation.
   Mechanism: Inhibits inflammatory cytokines.
   Side Effects: Increased eye pressure, cataract risk.

2. Topical Fluorometholone 0.1%
   Class: Corticosteroid
   Dosage & Time: One drop 4–6 times daily, taper over 6–8 weeks.
   Purpose: Milder steroid for patients at risk of pressure spikes.
   Mechanism: Anti-inflammatory via glucocorticoid receptors.
   Side Effects: Possible steroid-induced glaucoma.

3. Oral Acyclovir 400 mg Five Times Daily
   Class: Nucleoside analog antiviral
   Dosage & Time: 400 mg every 4 hours for 10 days.
   Purpose: Inhibits viral replication systemically.
   Mechanism: Incorporates into viral DNA, causing chain termination.
   Side Effects: Headache, nausea, rare kidney toxicity.

4. Oral Valacyclovir 500 mg Twice Daily
   Class: Pro-drug of acyclovir
   Dosage & Time: 500 mg orally every 12 hours for 10 days.
   Purpose: Improved bioavailability for deep corneal penetration.
   Mechanism: Converted to acyclovir in the body, blocks viral DNA polymerase Wikipedia.
   Side Effects: Headache, gastrointestinal upset.

5. Oral Famciclovir 250 mg Three Times Daily
   Class: Nucleoside analog antiviral
   Dosage & Time: 250 mg every 8 hours for 7–10 days.
   Purpose: Alternative oral antiviral.
   Mechanism: Converts to penciclovir, inhibits viral DNA synthesis.
   Side Effects: Headache, diarrhea.

6. Topical Ganciclovir 0.15% Gel
   Class: Antiviral nucleoside analog
   Dosage & Time: One drop 5 times daily until healing, then 3 times daily.
   Purpose: Directly inhibits corneal viral replication.
   Mechanism: Phosphorylated by viral kinases, blocks DNA polymerase.
   Side Effects: Mild irritation, blurred vision.

7. Topical Trifluridine 1% Drops
   Class: Fluorinated pyrimidine
   Dosage & Time: One drop every 2 hours while awake for 7–10 days.
   Purpose: Epithelial antiviral therapy adjunct.
   Mechanism: Inserts into viral DNA, causes faulty replication.
   Side Effects: Eye irritation, corneal toxicity with prolonged use.

8. Oral Foscarnet 40 mg/kg Three Times Daily
   Class: Pyrophosphate analog
   Dosage & Time: Reserved for acyclovir-resistant cases, 7–14 days.
   Purpose: Alternative for resistant HSV.
   Mechanism: Inhibits viral DNA polymerase directly.
   Side Effects: Nephrotoxicity, electrolyte imbalance.

9. Topical Loteprednol 0.5%
   Class: Soft corticosteroid
   Dosage & Time: One drop 4 times daily, tapering over 6 weeks.
   Purpose: Lower risk of pressure rise.
   Mechanism: Metabolized rapidly in the eye to inactive forms.
   Side Effects: Minimal intraocular pressure effect.

10. Long-Term Prophylactic Acyclovir 400 mg Twice Daily
    Class: Antiviral prophylaxis
    Dosage & Time: 400 mg orally twice daily for 6–12 months.
    Purpose: Prevents recurrence of stromal keratitis.
    Mechanism: Maintains low-level antiviral activity to suppress reactivation.
    Side Effects: Well-tolerated; occasional nausea EyeWorld.

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Dietary Molecular and Herbal Supplements

Some nutrients and herbs may support immune health or inhibit HSV replication; evidence varies.

1. L-Lysine (3 g/day)
   Dosage: 1 g three times daily.
   Function: May reduce HSV recurrence by balancing arginine.
   Mechanism: Competes with arginine, an amino acid HSV needs to replicate PMCEBSCO.

2. Vitamin C (1 g/day)
   Dosage: 500 mg twice daily.
   Function: Supports immune cell function and collagen synthesis.
   Mechanism: Antioxidant that scavenges free radicals.

3. Zinc (25 mg/day)
   Dosage: 25 mg once daily.
   Function: Enhances antiviral immunity and wound healing.
   Mechanism: Cofactor for immune enzymes and promotes epithelial repair.

4. Vitamin D (2,000 IU/day)
   Dosage: 2,000 IU once daily.
   Function: Modulates innate and adaptive immunity.
   Mechanism: Enhances antimicrobial peptide production.

5. Omega-3 Fish Oil (1 g EPA/DHA daily)
   Dosage: 1 g combined EPA/DHA.
   Function: Reduces inflammation systemically.
   Mechanism: Converts to resolvins that dampen inflammatory cytokines.

6. Echinacea (240 mg TID)
   Dosage: 240 mg three times daily during flare-ups.
   Function: May stimulate immune response.
   Mechanism: Activates macrophages and natural killer cells.

7. Propolis (500 mg/day)
   Dosage: 250 mg twice daily.
   Function: Antiviral and anti-inflammatory properties.
   Mechanism: Flavonoids inhibit viral entry and reduce cytokines.

8. Green Tea Extract (400 mg/day)
   Dosage: 400 mg standardized to 50% EGCG.
   Function: Antioxidant and modest antiviral activity.
   Mechanism: EGCG interferes with viral envelope fusion.

9. Curcumin (500 mg/day)
   Dosage: 500 mg once daily with black pepper.
   Function: Broad anti-inflammatory.
   Mechanism: Inhibits NF-κB and pro-inflammatory enzymes.

10. Astragalus (500 mg TID)
    Dosage: 500 mg three times daily.
    Function: Immune-boosting adaptogen.
    Mechanism: Activates T-cells and macrophages.

11. Selenium (100 mcg/day)
    Dosage: 100 mcg daily.
    Function: Cofactor for antioxidant enzymes.
    Mechanism: Protects tissues from oxidative damage.

12. Licorice Root (250 mg TID)
    Dosage: 250 mg three times daily.
    Function: Mild antiviral and soothing effect.
    Mechanism: Glycyrrhizin blocks viral attachment.

13. Beta-Carotene (15,000 IU/day)
    Dosage: 15,000 IU once daily.
    Function: Precursor to vitamin A, supports mucosal health.
    Mechanism: Supports epithelial integrity.

14. Elderberry (300 mg twice daily)
    Dosage: 300 mg two times daily.
    Function: Antiviral and immune stimulant.
    Mechanism: Inhibits viral adhesion and modulates cytokine release.

15. Melatonin (3 mg at bedtime)
    Dosage: 3 mg once nightly.
    Function: Regulates sleep and has antioxidant effects.
    Mechanism: Supports immune regulation and reduces oxidative stress.

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Regenerative and Stem-Cell-Derived Therapies

Emerging treatments aim to repair damaged corneal tissue and enhance regeneration.

1. Cenegermin (Recombinant NGF, 20 µg/mL)
   Dosage: One drop six times daily for 8 weeks.
   Function: Promotes nerve regeneration and epithelial healing.
   Mechanism: Binds to NGF receptors, stimulating corneal nerve growth.

2. Autologous Serum Eye Drops (20%)
   Dosage: One drop six times daily.
   Function: Mimics natural tears rich in growth factors.
   Mechanism: Provides EGF, fibronectin, and vitamin A to promote healing.

3. Platelet-Rich Plasma Drops
   Dosage: One drop four times daily.
   Function: Delivers concentrated growth factors.
   Mechanism: Platelet-derived factors stimulate cell proliferation.

4. Amniotic Membrane Extract (Lyophilized Eye Drops)
   Dosage: One drop three times daily.
   Function: Supplies anti-scarring and anti-inflammatory proteins.
   Mechanism: Releases hepatocyte growth factor and TGF-β inhibitors.

5. Recombinant Epidermal Growth Factor (10 µg/mL)
   Dosage: One drop five times daily.
   Function: Accelerates epithelial cell proliferation.
   Mechanism: Activates EGF receptors on corneal epithelial cells.

6. Mesenchymal Stem Cell Secretome Drops
   Dosage: One drop four times daily.
   Function: Delivers a mix of regenerative cytokines.
   Mechanism: Paracrine factors promote stromal and epithelial repair.

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Surgical Procedures

When medical therapy fails or scarring threatens vision, surgery may be needed.

1. Deep Anterior Lamellar Keratoplasty (DALK)
   Procedure: Replaces anterior corneal layers while preserving endothelium.
   Why: Removes scarred stroma and restores transparency with lower rejection risk.

2. Penetrating Keratoplasty (Full-Thickness Transplant)
   Procedure: Full-thickness donor cornea replaces host cornea.
   Why: Used for extensive scarring involving all layers.

3. Phototherapeutic Keratectomy (PTK)
   Procedure: Laser ablation of superficial stromal scars.
   Why: Smooths irregular scars, improving vision and surface quality.

4. Amniotic Membrane Transplant
   Procedure: Grafting biologic membrane onto cornea.
   Why: Provides anti-inflammatory and anti-scarring factors in refractory cases.

5. Tarsorrhaphy
   Procedure: Partial eyelid closure by suturing lids together.
   Why: Protects cornea in severe exposure or non-healing ulcers.

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Prevention Strategies

1. Acyclovir Prophylaxis: 400 mg twice daily reduces recurrence by 50% Wikipedia.

2. UV Protection: Wear sunglasses with UV filters outdoors.

3. Hand Hygiene: Wash hands before touching eyes.

4. Avoid Eye Rubbing: Prevents reintroduction of virus.

5. Manage Stress: Use relaxation techniques to lower HSV triggers.

6. Healthy Sleep: 7–8 hours nightly to maintain immune health.

7. Balanced Diet: Rich in vitamins A, C, D, and zinc.

8. Contact Lens Hygiene: Replace cases, disinfect lenses properly Wikipedia.

9. Avoid Sharing Towels: HSV spreads via contaminated linens.

10. Regular Eye Exams: Early detection prevents scarring.

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When to See a Doctor

• Severe Eye Pain not relieved by lubricants.

• Vision Blurring or sudden vision loss.

• Intense Redness of the white of the eye.

• New Light Sensitivity (photophobia).

• Worsening Symptoms despite treatment.

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Foods to Eat and Avoid

Eat:

1. Citrus fruits (vitamin C).

2. Leafy greens (vitamin A precursors).

3. Oily fish (omega-3 fatty acids).

4. Garlic (mild antimicrobial).

5. Yogurt (probiotics for immunity).

Avoid:

1. Nuts and seeds (high arginine).

2. Chocolate (arginine-rich).

3. Whole grains (moderate arginine).

4. Gelatin (arginine source).

5. Sunflower seeds (arginine-dense).

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FAQs

1. What causes stromal keratitis?
   It’s caused by reactivation of HSV in the cornea’s stroma, triggering immune-mediated inflammation.

2. Is stromal keratitis contagious?
   The virus can spread by direct contact, but stromal disease itself isn’t spreadable once inflammation starts.

3. How long does treatment last?
   Typically 10 days to 12 weeks, depending on severity and steroid taper schedules.

4. Can stromal keratitis cure completely?
   Early treatment often restores clarity, but deep scarring may persist in severe cases.

5. What are the main side effects of steroids?
   Increased eye pressure and cataract formation with prolonged use.

6. Are there home remedies?
   Supportive measures like cool compresses and lubricants can ease symptoms but don’t replace medical therapy.

7. Does dietary lysine really help?
   High-dose lysine (>3 g/day) may reduce recurrence, though evidence is mixed PMC.

8. When should I go to the hospital?
   If vision drops suddenly, pain intensifies, or redness spreads rapidly.

9. Can I wear contact lenses again?
   Only after full healing and with strict hygiene to prevent reinfection.

10. What’s the role of amniotic membrane?
    It provides growth factors and anti-scarring proteins for severe or non-healing ulcers.

11. Is surgery always needed?
    No—most cases respond to antiviral and steroid therapy; surgery is for refractory scarring.

12. How to prevent recurrence?
    Long-term prophylactic antivirals, UV protection, and stress management help reduce new outbreaks.

13. Can immunocompromised patients be treated?
    Yes, but they may need higher antiviral doses and closer monitoring for side effects.

14. Are stem-cell therapies standard?
    No—most are experimental, though early results for nerve growth factor (cenegermin) are promising.

15. Will I need glasses after healing?
    Possibly—residual scarring can distort vision, so corrective lenses or surgery may be required.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 06, 2025.

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