Keratitis including HSK (Herpes Simplex Keratitis)

Question 1

define keratitis

Answer 1

inflammation of the cornea

not like conjunctivitis
-it is potentially life threatening and should therefore be urgently evaluated and treated

Question 2

causes of keratitis 6

Answer 2

bacterial

fungal

amoebic

parasictic

viral

environmental

Question 3

typical bacterial causes of keratitis 2

Answer 3

Staph A- most common

Psuedomonas aeruginosa (seen in contact lens wearers)

Question 4

amoebic cause of keratitis 1
-*important syx

Answer 4

acanthamoebic keratitis

increased incidence if eye exposure to soil or contaminated water

*-pain classically out of proportion to findings

Question 5

parasitic cause of keratitis 1

Answer 5

onchocercal keratits (river blindness)

Question 6

viral cause of keratitis

Answer 6

herpes simplex keratitis

Question 7

environemtnal causes of keratitis 3

Answer 7

photokeratits -welders arc eye

exposure keratitis

contact lens acute red eye

Question 8

clinical features of keratitis 4

Answer 8

red eye- pain and erythema

photophobia

foreign body, gritty sensation

hypopyon- accumulation of white blood cells that form a whitish layer of fluid in the lower portion of the eye’s anterior chamber

Question 9

referring pateints with a painful red and and wear contact lenses

Answer 9

difficult to assess these patients
-need same day referral to eye specialist to rule out microbial keratitis

Question 10

managemetn of keratitis 3

Answer 10

stop using contacts until syx resolve

topical ABx
-quinilones

cycloplegia for pain relief

Question 11

complications of keratitis 4

Answer 11

corneal scarring

perforation

endophthalmitis

visual loss

Question 12

most common cause of keratitis

Answer 12

herpes simplex keratitis

Question 13

what is most commonly affected in the eye in herpes simplex keratitis

Answer 13

can cause inflam anywehre in the eye but most commonly affects the epithelial layer of the cornea

Question 14

if herpes simplex keratitis affects the stroma (layer between the epithelium and endothelium of the cornea) what is this called and what are complications of this 3

Answer 14

called stromal keratitis

assoc w complications:
-stromal necrosis
-vascularisation
-scarring

can lead to corneal blindness

Question 15

presentation of herpes simplex keratitis 6

Answer 15

painful red eye

photophobia

vesicles around the eye

foreign body sensation

watering eye

reduced visual acuity (can vary from subte to significant)

Question 16

diagnosis of herpes simplex keratitis 3

Answer 16

stainng with fluorescein will show a dendritic corneal ulcer
-dendritic describes the appearance of branching and spreading of the ulcer

slit-lamp examination

corneal swabs or scraping can be sued to isolate the virus using a viral culture or PCR

Question 17

managemetn of herpes simplex keratitis 3

Answer 17

painful red eye- same day ophthal referral

Mx options:
-aciclovir-topical or oral

gangliclovir eye gel

Question 18

management of stromal keratitis 2

Answer 18

topcial steroids alongside topical steroids to treat stromal keratitis

corneal transplant may be required after infection has resolved to treat corneal scarring

Question 19

common complicatiosn of wearing contact lenses 4

Answer 19

discomfort

dry eye

corneal infiltrates

giant papillary conjunctivitis

Question 20

serious complications of wearing contact lenses 3

Answer 20

corneal neovasculiarisation

corneal abrasion

infectious keratitis

Question 21

preventing complications in contact lens wearers

Answer 21

good contact lens hygiene

includes not sleeepig, showering or swimming while wearing contacts to reduce risk of serious complicaitrons

risk of infectious keratitis- can be reduced by using daily disposable contacts