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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Viral eye: Emerging insights into corneal and ocular surface viral infections
Marco Zeppieri, Matteo Capobianco, Alessandro Avitabile, Federico Visalli, Cosimo Mazzotta, Mutali Musa, Rosa Giglio, Daniele Tognetto, Caterina Gagliano, Francesco Cappellani
Marco Zeppieri, Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
Marco Zeppieri, Rosa Giglio, Daniele Tognetto, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste 34129, Italy
Matteo Capobianco, Federico Visalli, Department of Ophthalmology, University of Catania, Catania 95123, Italy
Alessandro Avitabile, Faculty of Medicine, University of Catania, Catania 95123, Italy
Cosimo Mazzotta, Caterina Gagliano, Francesco Cappellani, Department of Medicine and Surgery, University of Enna "Kore", Enna 94100, Italy
Mutali Musa, Department of Optometry, University of Benin, Benin 300283, Nigeria
Mutali Musa, Department of Ophthalmology, Africa Eye Laser Center Ltd, Benin 300211, Nigeria
Caterina Gagliano, Francesco Cappellani, Eye Center, G.B. Morgagni-DSV, Catania 95125, Italy
Co-corresponding authors: Marco Zeppieri and Caterina Gagliano.
Author contributions: Zeppieri M, Capobianco M, Mazzotta C, Visalli F, Musa M, Avitabile A, Giglio R, Tognetto D, Gagliano C, Cappellani F wrote the outline; Zeppieri M, Capobianco M, Mazzotta C, Visalli F, Musa M, Avitabile A, Cappellani F did the research and writing of the manuscript; Zeppieri M, Visalli F, Capobianco M, Mazzotta C, Musa M, Avitabile A, Giglio R, Tognetto D, Gagliano C, Cappellani F assisted in the writing of the draft and final paper; Zeppieri M, Gagliano C, Cappellani F were responsible for the conception and design of the study. Zeppieri M, Capobianco M, Mazzotta C, Visalli F, Musa M, Gagliano C, Cappellani F contributed to the scientific editing; Zeppieri M, Visalli F, Musa M, Avitabile A, Giglio R, Tognetto D, Gagliano C, Cappellani F assisted in the editing, making critical revisions of the manuscript and viewing all versions of the manuscript; all authors provided the final approval of the article.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Marco Zeppieri, MD, PhD, Department of Ophthalmology, University Hospital of Udine, p. le S. Maria della Misericordia 15, Udine 33100, Italy.
mark.zeppieri@asufc.sanita.fvg.it
Received: August 26, 2025
Revised: September 30, 2025
Accepted: November 21, 2025
Published online: December 25, 2025
Processing time: 121 Days and 20.3 Hours
Viral infections of the ocular surface significantly contribute to morbidity and visual impairment globally. The herpes simplex virus (HSV), adenovirus, cytomegalovirus (CMV), and human papillomavirus (HPV) are predominant pathogens impacting the cornea and conjunctiva, resulting in recurrent illness, epidemic outbreaks, and virus-associated neoplasia. Progress in virology, immunology, and molecular diagnostics has enhanced comprehension of host–virus interactions and introduced novel therapeutic opportunities. A narrative literature review was performed utilizing PubMed, Scopus, and Web of Science, encompassing papers published from 2000 to 2025, with a specific focus on research from 2020 onwards. Eligible publications were peer-reviewed clinical and experimental investigations, together with reviews that focused on epidemiology, etiology, diagnostic methodologies, and therapeutic alternatives. Research indicates that HSV keratitis is the predominant infectious cause of corneal blindness in high-income nations, although adenovirus persists in instigating epidemics of keratoconjunctivitis in the absence of licensed antiviral treatments. CMV keratitis, previously confined to immunocompromised persons, is now acknowledged in immunocompetent patients as a causative agent of corneal endotheliitis. HPV is associated with ocular surface squamous neoplasia, especially in areas with elevated ultraviolet exposure and high human immunodeficiency virus prevalence. Innovative molecular diagnostics, innovative antiviral agents, immunomodulatory approaches, and immunization initiatives signify significant progress that could enhance preventative and therapeutic results.
Core Tip: Viral infections of the ocular surface are prevalent and significant contributors to corneal and conjunctival disorders globally. The herpes simplex virus is a primary cause of infectious corneal blindness, adenoviruses are responsible for epidemic conjunctivitis outbreaks, cytomegalovirus is increasingly acknowledged as a cause of keratitis in immunocompetent individuals, and human papillomavirus plays a role in ocular surface squamous neoplasia. Progress in molecular virology, immunology, and diagnostics is transforming comprehension and management, while novel antivirals, immunotherapies, and vaccines present new avenues for prevention and treatment.
