Q. Will Cortisone drops used for corneal herpes cause any harmful effect?

Answered by
Dr. Vaibhev Mittal
and medically reviewed by Dr. Divya Banu M

Hi doctor,

I (female, 38 years) had my first outbreak of corneal herpes five months back. It was treated incorrectly by a GP first with Cortisone and antibiotics. The eye doctor put me on Acyclovir cream and later added Cortisone drops to prevent scars. After a month, while on vacation (lots of sun and salt water) it came back. I did not recognize the signs at first and thought the redness was only due to irritation. It lingered, so after coming back home, I was put on Acyclovir orally. Two months back, the dye did not show any active ulcers, so I could lower the oral dose to 400 mg and use Cortisone drops again. Last week for a check up the dye showed two active ulcers again.

I am really shocked and scared now. My doctor did not say if it was stromal keratitis or not. Is there a way to tell? I have always had 100 % vision since the lesions are not in front of the pupil. But I do not know why I had a recurrence even while on Acyclovir. Could the Cortisone drops be detrimental? My doctor said to increase the dose back to 800 mg and stop Cortisone.

Is there a way to clear this for now? I do not know if I had two relapses or if this never really healed in the first place. Is there a way to prevent such frequent outbreaks at all? It is difficult not to stress when I fear I will go blind.

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Dr. Vaibhev Mittal

DOMS., FELLOWSHIP IN COMPREHENSIVE OPHTHALMOLOGY
Ophthalmology (Eye Care)

Hello,

Welcome to icliniq.com.

Please do not panic. You will not go blind. I assume this is herpes simplex and you have herpes epithelial keratitis. Epithelium keratitis is usually treated with antiviral and lubricating eyedrop. The steroid has no role in epithelial keratitis. Steroid increases the risk of recurrence. That is why steroid is instilled undercover of antiviral. If there are more than two attacks in a single year, then we may need to continue prophylactic oral Acyclovir for a very long period (maybe years). With recurrent attacks, there may be scars which may blur your vision.

Hi doctor,

Thank you for your reply. Like I said, I am already taking Acyclovir orally but had a recurrence now while the dose was lowered (and possibly the Cortisone drops were a reason). Could you elaborate on how to tell the difference if it is stromal keratitis or epithelial? My doctor did not say anything about this and I only found out now that there is the stromal version with immune reaction which scares me a lot.

Dr. Vaibhev Mittal

DOMS., FELLOWSHIP IN COMPREHENSIVE OPHTHALMOLOGY
Ophthalmology (Eye Care)

Hello,

Welcome back to icliniq.com.

Yes, Cortisone may be a reason. Slit lamp examination is necessary to differentiate between two variants of herpes stromal keratitis. Stromal immune keratitis will need Acyclovir ointment, steroid eyedrop in tapering doses, oral Acyclovir (to prevent recurrence). Stromal immune keratitis will not resolve without steroid eyedrop.

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