Impact of COVID-19 pandemic on viral keratitis

COVID-19 has altered the epidemiology and clinical course of viral keratitis, with increasing evidence of herpesvirus reactivation after infection or vaccination. HSV keratitis remains most common in younger-to-middle-aged men, while HZO predominates in older adults and around one-fourth of HZO patients report current or prior COVID-19. HSV cases frequently recur and complications such as corneal opacity and neuropathic pain can cause vision outcomes ranging from normal to severe loss. Large recent studies suggest vaccination is associated with higher risk of new-onset and relapsing herpesviral keratitis, supporting antiviral prophylaxis for high-risk patients. Thus, screening around COVID-19 illness or vaccination and early, structured antiviral treatment reduces long-term visual impairment.