Herpes keratitis

Background

  • Most common cause of corneal blindness in US
  • Avoid topical steroids to prevent necrotizing stromal keratitis

Clinical Features

Herpes keratitis
  • Blurred vision
  • Eye pain, photophobia
  • Tearing
  • Perilimbic injection
  • Normal pupil size and intraocular pressure
  • Dendritic ulcers with fluorescein

Differential Diagnosis

Herpes Simplex Virus-1

Evaluation

Clinical diagnosis with staining and slit lamp exam

  • 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
  • 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

Management

  • Topical options
  • 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