Ocular surgery after herpes simplex and herpes zoster keratitis

Int Ophthalmol. 2020 Dec;40(12):3599-3612. doi: 10.1007/s10792-020-01539-6. Epub 2020 Sep 10.


Purpose: The recurrence of herpetic stromal keratitis (HSK) and herpes zoster ophthalmicus (HZO) has been reported after a variety of ocular surgeries. The aim of this study was to review the evidence on the preventive methods employed in the perioperative period in patients having undergone HSK/HZO.

Methods: The PubMed and Web of Science databases were the main resources used to conduct the medical literature search. An extensive search was performed to identify relevant articles concerning the prophylaxis against and risk of HSK/HZO recurrence in patients undergoing ocular surgery up to December 31, 2019.

Results: The disturbance of the corneal nerve plexus occurs during several ocular surgeries including penetrating keratoplasty, lamellar keratoplasty, corneal cross-linking, cataract surgery, as well as photorefractive and phototherapeutic procedures. Such trauma, as well as modulation of the ocular immunological response caused by steroids applied postoperatively, might engender the HSK/HZO reactivation which is not uncommon. There is strong evidence that oral prophylaxis should be recommended just after surgery in patients undergoing penetrating keratoplasty and having suffered from HSK/HZO. For other types of surgeries, the evidence is less compelling; nevertheless, a period of disease quiescence and oral prophylaxis should still be considered.

Conclusions: Within the article, we discuss the available evidence for HSK/HZO prophylaxis in ocular surgery. Additional studies would be required to define the real risk of HSK/HZO recurrence following eye surgeries, and particularly cataract surgery, and to confirm the utility of perioperative HSK/HZO prophylaxis.

Keywords: Cataract surgery; Herpes zoster ophthalmicus; Herpetic stromal keratitis; Keratoplasty; LASIK; Refractive surgery.

Publication types

  • Review

MeSH terms

  • Antiviral Agents / therapeutic use
  • Corneal Transplantation*
  • Herpes Zoster Ophthalmicus*
  • Humans
  • Keratitis, Herpetic* / surgery
  • Keratoplasty, Penetrating / adverse effects


  • Antiviral Agents