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Herpes simplex virus blepharitis - External and Internal Eye
See also in: Cellulitis DDx
Other Resources UpToDate PubMed

Herpes simplex virus blepharitis - External and Internal Eye

See also in: Cellulitis DDx
Contributors: Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS, Susan Burgin MD
Other Resources UpToDate PubMed


Herpes simplex virus blepharitis is an infection of the eyelid(s) with either herpes simplex virus 1 (HSV-1) or HSV-2 (less common). There is erythema, mild edema, and vesiculation of the eyelids and periocular skin. Presenting symptoms include pain and tenderness upon palpation of the affected area. There is increased lacrimation in severe cases.

The spectrum of ocular herpetic disease also includes conjunctivitis, iritis, and keratitis. Epithelial keratitis involves only the superficial layer of the cornea and is usually caused by active virus replication, while stromal keratitis involves deeper layers of the cornea affected by immunologic responses. Both can lead to corneal scarring and vision loss.

Primary ocular HSV infections occur most often in children. They are usually unilateral, mild infections that often go unrecognized, although they may present as blepharitis or blepharoconjunctivitis. Most symptomatic attacks are recurrences, more commonly presenting as a keratitis, although there have been several reports of recurrent HSV blepharitis.

The treatment of HSV blepharitis is supportive as most cases are self-limiting and resolve within 2-3 weeks. Corneal involvement with HSV, discussed elsewhere, necessitates treatment with antiviral agents to prevent complications.

HSV blepharitis can be differentiated from preseptal or orbital cellulitis on the basis of vesicles and ulcerations.

Immunocompromised Patient Considerations:
  • Human immunodeficiency virus (HIV) patients have a higher rate of incidence and recurrence of HSV ocular disease (mainly reported for keratitis) and may take longer to heal, but the ocular manifestations of the disease are not notably more severe.
  • Generally speaking, in the immunocompromised patient, HSV infections can present the same as in the immunocompetent patient or manifest with thick hemorrhagic crusts, eschars, persistent large erosions, or ulcers. Widespread dissemination to skin and internal organs, including lungs and liver, may occur (see disseminated HSV). In patients with HIV / AIDS, HSV infections can be severe and chronic.


B00.59 – Other herpesviral disease of eye

186544000 – Herpes simplex eyelid dermatitis

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Last Reviewed:09/08/2019
Last Updated:09/18/2019
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Herpes simplex virus blepharitis - External and Internal Eye
See also in: Cellulitis DDx
A medical illustration showing key findings of Herpes simplex virus blepharitis (HSV Blepharitis) : Eye pain, Eyelid edema, Unilateral distribution, Conjunctival injection, Vesicles
Clinical image of Herpes simplex virus blepharitis - imageId=248988. Click to open in gallery.  caption: 'Grouped pustules on an erythematous base on the upper eyelid.'
Grouped pustules on an erythematous base on the upper eyelid.
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