Herpes simplex keratitis: Difference between revisions
ClaireLewis (talk | contribs) |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 5: | Line 5: | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Herpes simplex geographic corneal ulcer.jpeg|thumbnail|Herpes keratitis]] | [[File:Herpes simplex geographic corneal ulcer.jpeg|thumbnail|Herpes keratitis]] | ||
*Blurred vision | [[File:HSVconjuctivitis.png|thumbnail]] | ||
*[[Blurred vision]] | |||
*[[Eye pain]], photophobia | *[[Eye pain]], photophobia | ||
**More pain than with typical conjunctivitis | |||
*Tearing | *Tearing | ||
*Perilimbic injection | *Perilimbic injection | ||
*Normal pupil size and intraocular pressure | *Normal pupil size and [[intraocular pressure]] | ||
*Dendritic ulcers with fluorescein | *Dendritic ulcers with fluorescein | ||
*Severe cases may cause [[uveitis]], [[iritis]] | |||
== | ===[[Slit lamp]]/Fluorescein=== | ||
== | |||
*Epithelial disease | *Epithelial disease | ||
**Infectious epithelial keratitis | **Infectious epithelial keratitis | ||
| Line 34: | Line 24: | ||
***Irregular corneal surface from immune response | ***Irregular corneal surface from immune response | ||
***Decreased corneal sensitivity due to scarring, necrosis | ***Decreased corneal sensitivity due to scarring, necrosis | ||
*Stromal keratitis - develops secondarily to in 25% of patients with epithelial disease | *Stromal keratitis - develops secondarily to in 25% of patients with epithelial disease | ||
**Necrotizing stromal keratitis - leads to thinning and perforation | **Necrotizing stromal keratitis - leads to thinning and perforation | ||
**Immune stromal keratitis - recurrent ocular HSV | **Immune stromal keratitis - recurrent ocular HSV | ||
*Endotheliitis (disease extending from epithelium to stroma to endothelium) | *Endotheliitis (disease extending from epithelium to stroma to endothelium) | ||
**Keratic precipitates | **Keratic precipitates | ||
**Accompanying iritis | **Accompanying iritis | ||
==Differential Diagnosis== | |||
*[[Iritis]] | |||
*[[Conjunctivitis]] | |||
*[[Glaucoma]] | |||
*[[UV keratitis]] | |||
*[[Herpes zoster]] | |||
*[[Contact lens]] complication | |||
*Fungal keratitis | |||
*[[Bacterial keratitis]] | |||
*Interstitial keratitis | |||
{{HSV-1 DDX}} | |||
==Evaluation== | |||
''Clinical diagnosis with staining and slit lamp exam'' | |||
==Management== | ==Management== | ||
*Topical options | *Topical options | ||
**[[Ganciclovir]] optho gel 0.15% 5x daily | **[[Ganciclovir]] optho gel 0.15% 5x daily | ||
**Cycloplegic for symptoms - [[Cyclopentolate]] 1% x1 drop TID, lasts for a day | **[[Cycloplegic]] for symptoms - [[Cyclopentolate]] 1% x1 drop TID, lasts for a day | ||
*Oral [[acyclovir]] or [[valacyclovir]] may be used alone or in combo with topical | *Oral [[acyclovir]] or [[valacyclovir]] may be used alone or in combo with topical | ||
*Avoid topical steroids unless in consult with ophtho (steroids can be started when infectious treatment adequately underway) | *Avoid topical steroids unless in consult with ophtho (steroids can be started when infectious treatment adequately underway) | ||
| Line 63: | Line 66: | ||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
[[Category:ID]] | |||
Revision as of 16:56, 5 October 2019
Background
- Most common cause of corneal blindness in US
- Avoid topical steroids to prevent necrotizing stromal keratitis
Clinical Features
- Blurred vision
- Eye pain, photophobia
- More pain than with typical conjunctivitis
- Tearing
- Perilimbic injection
- Normal pupil size and intraocular pressure
- Dendritic ulcers with fluorescein
- Severe cases may cause uveitis, iritis
Slit lamp/Fluorescein
- Epithelial disease
- Infectious epithelial keratitis
- Corneal vesicles rarely seen; dendritic ulcers form from coalesced corneal vesicles
- Enlarge into geographic ulcers, with scalloped borders
- Neurotrophic keratopathy
- Ulcers more oval, with smooth borders as opposed to geographic ulcers
- Irregular corneal surface from immune response
- Decreased corneal sensitivity due to scarring, necrosis
- Infectious epithelial keratitis
- Stromal keratitis - develops secondarily to in 25% of patients with epithelial disease
- Necrotizing stromal keratitis - leads to thinning and perforation
- Immune stromal keratitis - recurrent ocular HSV
- Endotheliitis (disease extending from epithelium to stroma to endothelium)
- Keratic precipitates
- Accompanying iritis
Differential Diagnosis
- Iritis
- Conjunctivitis
- Glaucoma
- UV keratitis
- Herpes zoster
- Contact lens complication
- Fungal keratitis
- Bacterial keratitis
- Interstitial keratitis
Herpes Simplex Virus-1
- Eczema herpeticum
- Herpes gingivostomatitis
- Herpes keratitis
- Herpes labialis (cold sore)
- Herpes simplex encephalitis
- Herpetic whitlow
Evaluation
Clinical diagnosis with staining and slit lamp exam
Management
- Topical options
- Ganciclovir optho gel 0.15% 5x daily
- Cycloplegic for symptoms - Cyclopentolate 1% x1 drop TID, lasts for a day
- Oral acyclovir or valacyclovir may be used alone or in combo with topical
- Avoid topical steroids unless in consult with ophtho (steroids can be started when infectious treatment adequately underway)
Disposition
- Usually self-limiting with most experiencing resolution within 3 wks
- Outpatient consult to ophtho for refractory cases, ulcers needing debridement, and multiple recurrences
See Also
External Links
References
- Wang, J et al. Herpes Simplex Keratitis. Dec 7 2015. http://emedicine.medscape.com/article/1194268-overview#showall