Infective keratitis

Question 1

In patients with any disease of the cornea, which of the following is common in nearly all patients?

1 - red eye
2 - photophobia
3 - foreign object feeling
4 - dry eyes

Answer 1

2 - photophobia

Typically acute in onset

Question 2

Which 2 of the following should always be asked about in patients who present with suspected corneal disease?

1 - autoimmune conditions
2 - cold sore history
3 - swimming history
4 - contact lens history

Answer 2

2 - cold sore history

4 - contact lens history

Question 3

Which 2 of the following can cause dry eye and lead to corneal disease?

1 - blepharitis
2 - eczema
3 - glaucoma
4 - cataracts

Answer 3

1 - blepharitis
2 - eczema

Question 4

Herpes simplex keratitis (HSK) is a common and potentially sight-threatening ocular infection caused primarily by herpes simplex virus type 1 (HSV-1) and, less frequently, by herpes simplex virus type 2 (HSV-2). What is the incidence of HSK?

1 - 1400 cases per 100,000
2 - 140 cases per 100,000
3 - 14 cases per 100,000
4 - 1.4 cases per 100,000

Answer 4

3 - 14 cases per 100,000

Equally likely in males and females

Question 5

At what age does the incidence of Herpes simplex keratitis (HSK) peak?

1 - 20-30
2 - 30-40
3 - 40-50
4 - >70

Answer 5

4 - >70

Question 6

HSV enters the host through mucosal surfaces or small skin abrasions, establishing latency in the trigeminal ganglion, meaning it is never truly gone. Does this mean that Herpes simplex keratitis is likely to relapse and return also?

Answer 6

• yes

Question 7

In herpes simplex keratitis patients typically have a red eye, is this painful or not?

Answer 7

• very painful

Question 8

In herpes simplex keratitis, is photophobia present?

Answer 8

• always

Question 9

All of the following are symptoms a patient with herpes simplex keratitis may present with, EXCEPT which one?

1 - green discharge
2 - epiphora (excessive watering)
3 - loss of visual acuity
4 - fluorescein staining may show an epithelial ulcer
5 - vision loss in severe cases

Answer 9

1 - green discharge
- commonly associated with bacterial infections

Question 10

In herpes simplex keratitis there is superficial corneal involvement that presents as what following fluorescein staining?

1 - corectopia ulcer
2 - dendritic ulcer
3 - adenoma ulcer
4 - macrophagic ulcer

Answer 10

2 - dendritic ulcer

As looks like a dendrocyte

Can also progress to a geographical ulcer, which is larger and more serious if untreated

Question 11

To diagnose herpes simplex keratitis, which of the following imaging modalities can be used?

1 - Slit-lamp examination
2 - Fluorescein staining
3 - Confocal microscopy
4 - all of the above

Answer 11

4 - all of the above

Viral PCR and culture can also aid with diagnosis

Question 12

Which 2 of the following are 1st line treatments for herpes simplex keratitis?

1 - trifluridine
2 - chloramphenicol
3 - ganciclovir
4 - vitamin A

Answer 12

1 - trifluridine
3 - ganciclovir

5 x day for 2 weeks

Both are antivirals

Long-term prophylaxis with oral antiviral agents may be necessary in patients with frequent recurrences.