Herpes simplex keratitis

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Background

  • Also known as herpetic keratoconjunctivitis and herpesviral keratitis
  • Conjunctivitis alone or may involve cornea, eyelids, and skin
  • Higher rate in HIV patients
  • Stress, fever, trauma, or UV light can trigger reactivation
  • Severe cases may cause uveitis, iritis, and increased intraocular pressure

Clinical Features

Herpes simplex keratitis
HSVconjuctivitis.png
  • Usually unilateral with palpable preauricular node
  • More pain than usual conjunctivitis
  • Foreign body sensation

Differential Diagnosis

Conjunctivitis Types

Evaluation

Workup

  • Slit-lamp with fluorescein
  • Must evaluate for corneal involvement (keratitis)
    • Slit-lamp fluorescein findings: Pinpoint or dendritic lesions

Diagnosis

Severe

  • Any of the following:
    • Skin involvement (e.g. eyelids)
    • Photophobia
    • Decreased vision
    • Corneal lesion
    • Flare in ant chamber

Management and Disposition

Do not give steroids

Mild

  • Cool compresses
  • Trifluridine 1% drops 5x per day x 10-14d
  • Follow-up ophtho 2-5d to monitor for corneal involvement

Severe

  • Trifluridine 1% drops 9x per day x 7-10d AND
  • Oral acyclovir 400mg PO 5x per day x 7-10d
  • Consider cycloplegic agent if flare in anterior chamber
  • Follow-up with ophtho within 2d

See Also

References

  • Mahmood, Narang. Diagnosis and management of acute red eye. Emerg Med Clin N Am. 2008;26