Herpes Keratitis

Question 1

What is herpes keratitis?

Answer 1

Infection of the cornea caused by HSV

Question 2

Where does herpes keratitis usually occur?

Answer 2

Only affects epithelial layer of cornea

Question 3

What is it called if there is inflammation of the stroma?

Answer 3

Stromal keratitis which has complications such as

• Stromal necrosis
• Vascularisation
• Scarring

Question 4

Presentation of herpes keratitis?

Answer 4

• Painful red eye
• Photophobia
• Foreign body sensation
• Watering eye
• Reduced visual acuity
• Vesicles around eye

Question 5

Most common causes of herpes keratitis?

Answer 5

Viral infection with herpes simplex

Question 6

Other causes of herpes keratitis?

Answer 6

• Bacterial infection with pseudomonas or staphylococcus
• Fungal infection with candida or aspergillus
• Contact lens acute red eye (CLARE)
• Exposure keratitis

Question 7

What is herpes simplex keratitis?

Answer 7

-Inflammation in any part of the eye, mostly epithelial layer of cornea
Can be primary or recurrent

Question 8

Diagnosis/investigation of herpes keratitis?

Answer 8

• Fluorescein: shows dendritic corneal ulcer
• Slit lamp exam: Finds & diagnosis keratitis
• Corneal swabs/scrapings: Isolates virus using culture or PCR

Question 9

Management of herpes keratitis?

Answer 9

Same day referral

Secondary care:
-Aciclovir (topical/oral)

• Ganciclovir eye gel
• Corneal transplant: after infection resolution to treat corneal scarring caused by stromal keratitis

Question 10

Presents with?

Answer 10

Dendritic ulcer

Question 11

What NOT to give herpetic keratitis?

Answer 11

STEROIDS: Cause corneal melt and perforation