Herpes Simplex Keratitis

Question 1

What is the aetiology/cause of herpes simplex keratitis?

Answer 1

HSV in cornea

Question 2

What are the risk factors for herpes simplex keratitis?

Answer 2

• Poor general health
• Immunodeficiency
• Fatigue
• Steroid use

Question 3

What are the symptoms for herpes simplex keratitis?

Answer 3

• Unilateral, Acute, Pain, Redness
• Photophobia
• Watery Eyes
• Blurred Vision
• May have eyelid/skin involvement

Question 4

What are the signs of herpes simplex keratitis?

Answer 4

1. Dendritic Ulcer - dendriform pattern, reduced contrast sensitivity and sub-epithelial haze (typically central and stains with fluoroscein)
2. Herpes disciform keratitis - folds in descements membrane, may lead to anterior uveitis (central zone of stromal oedema and overlying epithelial oedema)

Question 5

What is the referral for herpes simplex keratitis?

Answer 5

If recurrent HSK + no stromal involvement = URGENT to OP

If Stroma involved, CL wearer, children, bilateral = EMERGENCY

Question 6

What is the treatment for herpes simplex keratitis?

Answer 6

Anti-Viral Therapy: Aciclovir 3% ointment or Ganciclovir 0.15% gel

Possible corneal biopsy to confirm virus

Debridement (wipe cornea with sterile sponge around edge of lesion to reduce viral load)

DO NOT GIVE TOPICAL STEROIDS