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Herpetic keratitis

  • recurrent HSV is the leading cause of blindness due to corneal issues requiring corneal transplant in Western societies
  • it is usually unilateral but may be bilateral
  • 3 main types
    • epithelial type
      • incubation period 1-28 days
      • initial infection may be subclinical or may present as conjunctivitis
      • clinical presentations are generally of eye pain, tearing, red eye and photophobia and slit lamp examination with flourescein staining may reveal the classic dendritic ulcers, or the later, deeper and larger geographic ulcers
    • Immune herpetic stromal keratitis
      • an inflammatory reaction to the virus particles in a deeper layer of the cornea
      • usually presents following the initial infection as a recurrence but presents with similar symptoms as epithelial type
    • Necrotizing stromal keratitis
      • the most severe form
      • usually only occurs after patient has already had several recurrences of herpetic keratitis
      • virus destroys the corneal tissue and causes an inflammatory reaction and may lead to perforation
  • diagnosis
    • clinical examination with slit lamp +/- PCR swab
  • treatment
    • specialist assessment is advisable as each type requires different treatment
    • EARLY ORAL antivirals such as fancicyclovir
    • avoid topical antivirals as these may cause further corneal damage
    • some types also need topical steroids
keratitis.txt · Last modified: 2019/11/04 10:23 (external edit)