Herpes Infection Flashcards
What is keratitis?
Inflammation of the cornea
What are the causes of keratitis?
- Viral - HSV (commonly)
- Bacterial - pseudomonas/staphylococcus
- Fungal - candida/aspergillus
- Contact lens acute red eye (CLARE)
- Exposure - inadequate eyelid coverage (ectropion)
What are the complications of stromal keratitis?
Stromal necrosis, vascularisation, scarring, corneal blindess.
What is this a presentation of:
Painful red eye, photophobia, vesicles around the eye, foreign body sensation, watering eye, reduced visual acuity?
Herpes keratitis
How is herpes keratitis diagnosed?
- Fluorescein staining - dendritic corneal ulcer (branching and spreading appearance)
- Slit-lamp examination for diagnosis of keratitis
- Corneal swabs or scraping - isolate virus using culture/PCR
What is the treatment for herpes keratitis?
- Aciclovir - topical/oral
- Ganciclovir eye gel
- Topical steroids alongside antivirals for stromal keratitis
How is corneal scarring treated?
Corneal transplant after infection has resolved.
What is reactivated in herpes zoster ophthalmicus and where is it reactivated?
VZV
Area supplied by ophthalmic division of the trigeminal nerve.
What is this a presentation of:
Vesicular rash around eye (can involve actual eye), rash on tip/side of nose.
Herpes zoster ophthalmicus
Rash on nose - Hutchinson’s sign - indicates nasociliary involvement and is a risk factor for ocular involvement.
What is the treatment for herpes zoster ophthalmicus?
- Oral antiviral treatment for 7-10 days started within 72 hours, can be IV for severe infection or if patient is immunocompromised.
- Topical corticosteroids for secondary eye inflammation.
- Urgent ophthalmology review if there is ocular involvement.
What are the complications of herpes zoster ophthalmicus?
- Ocular - conjunctivitis, keratitis, episcleritis, anterior uveitis.
- Ptosis
- Post-herpetic neuralgia
