Disorders of the Cornea and Anterior Segment

Question 1

Viral keratitis

Answer 1

OCULAR - HSV can cause keratitis, retinitis, iritis/uveitis, conjunctivitis, blepharitis and surrounding dermatitis. Mainly HSV1 rarely 2.
Most primary are asymptomatic.
Herpes simplex keratitis is the condition most commonly misdiagnosed as conjunctivitis.

Signs and symptoms:
- Lack of any significant discharge,
- Small pupil,
- Photophobia,
- Watering eye and
- Discomfort felt should refer the patient to optometrist or GP for ophthalmologist referral.
Other symptoms: eye pain/irritation, blurred vision, visual acuity.

Branching patterns of the dendritic ulcer are the key diagnostic features however, needs ophthalmoscope or slit lamp to diagnose. Also use symptoms to diagnose. Fluorescein staining used to see branching patterns.

Treatement
1st line:
- Ganciclovir topical (5/day till healing complete then TDS for 7 days - don’t exceed 21 days usually),
- aciclovir topical (1cm 5/day continue 3 days after full healing),
CAN add steroids.

2nd line: Trifluothymide (unlicensed) 1% eye drops

Question 2

Bacterial keratitis

Answer 2

Vision may be affected and = URGENT medical attention.

Cultures to identify the pathogen must be done b4 treatment.

Treatement
Leeds hospital trust:
Single therapy:
- fluoroquinolone, (Ofloxacin)
Dual therapy:
- fortified cephalosporin (Cefuroxime 5%) and aminoglycoside (Gentamicin 1.5%) eye drop or a fluoroquinolone.

Question 3

Corneal infiltrate/ Ulcer

Answer 3

Use of contact lenses is a predisposing factor.

The patient’s contact lenses, lens case, cleansing and storage solutions are usually found to be heavily contaminated place of infection.

The patient should be referred urgently for investigation and treatment.

Most common signs and symptoms:
- Red eye with over-expressed tears and discharge,
- Ocular pain,
- Photophobia,
- Foreign body sensation and
- Decreased vision.

Treatement
Analgesic paracetamol,
Or if possible, risk of infection then chloramphenicol