Herpes simplex keratitis: An epidemiological and public health review

Herpes simplex keratitis (HSK) is a leading and long-recognised cause of corneal blindness worldwide, with an epidemiological profile that remains incompletely characterized. Declining childhood acquisition of herpes simplex virus type 1 (HSV-1) in developed nations has delayed primary infection into adolescence and adulthood, predisposing this population to primary infection at a time when incident disease may be more likely to yield severe corneal manifestations. Concurrently, persistently high HSV-1 seroprevalence in developing regions underscores a disproportionate global burden that remains inadequately characterized. Epidemiological data specific to HSK suggest an upwards trend in the incidence of disease in developed nations, though significant study limitations, methodological heterogeneity, and biases caution against this conclusion. Additionally, there is a relative paucity of data on HSK from developing regions which are disproportionately affected by latent HSV infection. While antiviral therapy has reduced rates of severe vision loss and penetrating keratoplasties performed for HSK, the disease continues to impose significant quality-of-life and socioeconomic costs, particularly through recurrent episodes during economically productive years. Emerging antiviral resistance and the absence of an effective vaccine further underscore the need for improved surveillance and novel preventive strategies. By contextualizing HSK within evolving global epidemiological trends, this review highlights key gaps in population-level data and outlines priorities for future research and public health planning to reduce the significant and lifelong morbidity associated with HSK.