How herpes keratitis affects your eye
Herpes simplex virus (HSV), the same virus that causes cold sores, can infect the cornea, the clear front window of the eye. It can cloud the cornea and is believed to be the leading infectious cause of blindness in the developed world. One estimate puts new cases at about 1.5 million a year worldwide, including 40,000 that cause severe vision loss in one eye.[1]
Herpes keratitis isn’t one problem. A widely used classification sorts it into four types: infection of the surface layer, neurotrophic keratopathy (damage from loss of the cornea’s nerves), stromal keratitis (inflammation deeper in the cornea), and endotheliitis (inflammation of the inner cell layer).[2] Each leaves different after-effects:
- Scarring and an uneven surface. Stromal disease can leave the cornea cloudy and irregular. Glasses can’t correct the distortion an uneven surface causes.
- A numb cornea. Herpes is one of the common causes of neurotrophic keratitis, in which damaged nerves leave the cornea less sensitive and slow to heal.[5]
- Recurrences. Herpes eye disease can flare again. In a trial of 703 people who had had herpes eye disease in the previous year, 32% of those on placebo had a recurrence in the eye within 12 months, compared with 19% of those taking acyclovir tablets. Among people with a history of stromal keratitis, stromal keratitis returned in 28% on placebo and 14% on acyclovir.[3]
A 2026 review describes herpes keratitis as a mix of active virus, immune inflammation, and nerve damage. Standard care is antiviral medicine for the virus, steroids for deeper inflammation, and treatment of the surface. It lists scleral lenses among the options for the nerve-damage part.[4]
How a scleral lens helps
A scleral lens is a large rigid gas-permeable lens. It rests on the sclera (the white of the eye) and arches over the entire cornea without touching it. Before insertion it is filled with sterile saline, which sits against the cornea while the lens is worn.
- Clearer vision over a scar. The saline fills in the uneven surface that scarring leaves, which largely cancels it out optically. A 2025 review lists scars from infections such as herpetic stromal keratitis among the common reasons for fitting.[10] In a series of six eyes with central corneal scars (causes not stated in the abstract), average vision improved from 20/80 in glasses to 20/25 with mini-scleral lenses.[13]
- Protection for a numb surface. A numb cornea dries and breaks down easily. The saline keeps it moist, and the blinking lid slides over the lens instead of the fragile surface. Our neurotrophic keratitis page covers this use in detail.
What the research shows
The evidence is case reports and small series, mostly mixed in with other conditions. We found no study of scleral lenses in a group of people with herpes alone.
- Neurotrophic keratitis, including herpes-related. A 2021 review found no randomized trials of contact lenses for neurotrophic keratopathy. Case reports and limited case series suggest scleral lenses can be safe and effective at any stage, protecting the surface and sometimes improving vision.[6]
- Cloudiness that faded. A case series from a specialist center described four people whose long-standing corneal cloudiness improved after consistent PROSE lens wear, without steroids. One had presumed herpes simplex keratitis with a numb cornea.[8] Four selected cases don’t tell you how often this happens.
- Clear vision, then an infection. A 64-year-old man with herpes-related neurotrophic keratitis in both eyes saw his vision improve from 20/100 to 20/20 with scleral lenses. He later developed a corneal infection (microbial keratitis) linked to problems with lens care. It responded to antibiotic treatment and healed without further vision loss. The authors stress detailed care instructions.[7]
- Shingles scars. A 2017 review of corneal scarring from the shingles virus (herpes zoster) lists scleral lenses among the options, alongside laser and transplant surgery, and notes a lack of prospective studies.[9]
Why a numb eye needs extra care
Pain is one of the main warning signs of a corneal infection. When the cornea has lost feeling, that warning may be weak or missing. A 2021 review notes that reduced corneal sensation blunts or removes the pain response to infection, and advises extreme caution with any contact lens on a neurotrophic cornea.[11]
Herpes can also involve the cornea’s inner cell layer, the endothelium, which keeps the cornea clear.[2] A 2019 review lists low endothelial cell density as a potential contraindication to scleral lenses, because they reduce the oxygen reaching the cornea.[12] If herpes has affected that layer, ask whether your cell count has been checked.
Other options, compared
| Option | What it does | Typically suited to |
|---|---|---|
| Antiviral tablets or drops | Suppress the virus and lower recurrences | Active infection; prevention after stromal keratitis[3] |
| Steroid drops | Calm deeper immune inflammation | Stromal keratitis, as prescribed[4] |
| Serum drops, nerve growth factor drops, other growth-factor treatments | Support a numb, slow-healing surface | Neurotrophic keratopathy[4] |
| Glasses or soft lenses | Correct regular prescription | Little or no surface irregularity |
| Corneal rigid gas-permeable lenses | Smooth the surface on the cornea | Irregular scars, when sensation and the surface allow |
| Scleral lenses | Smooth the surface and protect it with saline | Irregular scars, numb corneas, or both |
| Corneal transplant | Replaces scarred tissue | Deep scarring that limits vision despite lenses |
Questions to ask a scleral lens fitter
- Has my cornea specialist cleared my eye for a lens fitting?
- How much feeling does my cornea have, and how does that change my follow-up?
- Should I be on preventive antiviral medicine?
- Has my endothelial cell count been checked?
- What signs mean I should remove the lens and call you the same day?
- How many herpes patients have you fitted?
Common questions
Can a scleral lens bring back a herpes infection?
We found no study showing that scleral lenses trigger herpes recurrences. Herpes eye disease comes back in many people regardless. If your eye becomes red, painful, light-sensitive, or blurrier, take the lens out and call your eye doctor that day.
Should I take antiviral medicine while I wear scleral lenses?
That is a decision for your cornea specialist. In a large trial, a year of preventive acyclovir halved recurrences of herpes stromal keratitis. Whether you need it depends on your history, not on the lens.
My cornea is numb after herpes. Is a scleral lens safe?
It can be used, and it is one of the treatments for a numb (neurotrophic) cornea. But a numb eye may not hurt when an infection starts. Strict lens hygiene, regular check-ups, and paying attention to redness, discharge, or blurring matter more than usual.
Will a scleral lens get rid of my herpes scar?
It doesn't remove the scar. It corrects the uneven surface the scar creates, which is often the bigger cause of blur. In a few case reports, cloudiness faded over months of lens wear, but that can't be expected.
Does this apply to shingles in the eye too?
Partly. The shingles virus can also scar the cornea and leave it numb, and a 2017 review lists scleral lenses among the options for those scars. The evidence is even thinner than for herpes simplex.