page_title: Herpes simplex keratitis
section_title: Primary infection
hierarchical_section_title: Herpes simplex keratitis / Signs and symptoms / Primary infection
caption_attribution_description: English: Herpetic blepharitis: Swelling and erythema of the eyelids along with erosions and ulcerations of the lid margins can be seen.
context_page_description: Herpetic simplex keratitis is a form of keratitis caused by recurrent herpes simplex virus infection in the cornea.
  It begins with infection of epithelial cells on the surface of the eye and retrograde infection of nerves serving the cornea. Primary infection typically presents as swelling of the conjunctiva and eyelids, accompanied by small white itchy lesions on the corneal surface. The effect of the lesions varies, from minor damage to the epithelium, to more serious consequences such as the formation of dendritic ulcers. Infection is unilateral, affecting one eye at a time. Additional symptoms include dull pain deep inside the eye, mild to acute dryness, and sinusitis. Most primary infections resolve spontaneously in a few weeks. Healing can be aided by the use of oral and topical antivirals.
  Subsequent recurrences may be more severe, with infected epithelial cells showing larger dendritic ulceration, and lesions forming white plaques. The epithelial layer is sloughed off as the dendritic ulcer grows, and mild inflammation may occur in the underlying stroma of iris. Sensation loss occurs in lesional areas, producing generalised corneal anaesthesia with repeated recurrences.
context_section_description: Primary infection most commonly manifests as blepharoconjunctivitis i.e. infection of lids and conjunctiva that heals without scarring. Lid vesicles and conjunctivitis are seen in primary infection. Corneal involvement is rarely seen in primary infection.
caption: herpetic blepharitis
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