Keratitis

Question 1

NB// In CL-wearer, should not diagnose HSV keratitis or marginal keratitis

Dendritic ulceration which can be seen in the former can also be seen in acanthamoeba keratitis.

In CL-wearer, we assume painful red eye is microbial keratitis until proven otherwise, and more specifically, bacterial in cause.

Question 2

Management of HSV keratitis?

Answer 2

Ganciclovir eye ointment

Question 3

Investigation of suspected HSV keratitis?

Answer 3

Fluorescein staining and examination of cornea

Take corneal scrapings for MC&S, PCR. Numbing eye drops given first.

(+ Dilated funds exam to check for retinitis (done routinely))

Question 4

How to differentiate HSV Keratitis and Herpes Zoster Ophthalmicus clinically ?

Answer 4

Herpes Zoster Ophthalmicus will have accompanying painful vesicular rash in distribution of ophthalmic branch of trigeminal nerve

Question 5

How does management of Herpes Zoster Ophthalmicus differ to HSV Keratitis?

Answer 5

For Herpes Zoster Ophthalmicus you always give Oral Aciclovir (800mg five times a day for 10 days), regardless of whether there is actual corneal involvement.

i.e. you can get infection of V1 distribution whilst not affecting cornea.

If no corneal involvement, can be discharged from ophthal on oral acivlovir with safety netting advise to return if red painful eye

If corneal involvement, add additional ganciclovir ointment to eye 5 times a day for 10 days