Biomarkers and Emerging Therapeutic Strategies in HSK: Bridging Diagnostics and Treatment

Herpes simplex keratitis (HSK) remains a major global cause of corneal blindness, with frequent viral recurrences leading to progressive corneal damage despite the use of antivirals and corticosteroids. This review aims to highlight the limitations of current therapeutic strategies and evaluate emerging prognostic and diagnostic biomarkers that may enable earlier detection, improved disease monitoring, and personalized treatment approaches in HSK.

A comprehensive review of recent literature was conducted, focusing on studies examining the pathophysiology of HSK, current treatment challenges, and the role of emerging biomarkers in viral entry, replication, inflammation, and corneal tissue remodeling. Particular emphasis was placed on evaluating the clinical utility of aptamer-based detection tools, heparanase activity assays, and matrix metalloproteinase profiles in diagnosing and predicting HSK severity and recurrence.

Evidence indicates that while antivirals and corticosteroids remain essential for managing acute HSK episodes, their effectiveness is limited by high recurrence rates and the adverse effects associated with prolonged steroid use. Biomarkers such as aptamers, heparanase, and matrix metalloproteinases show strong potential as tools for early detection, monitoring viral activity, and assessing disease severity. These biomarkers correlate with key pathogenic mechanisms, suggesting their utility in therapeutic strategies.

Conventional HSK management is hindered by treatment-related complications. Integrating these biomarkers into clinical practice may help preserve corneal structure, and ultimately improve visual outcomes for patients with HSK.