Midterm 2: Herpes Simplex Virus and Zoster

Question 1

What virus is the leading cause of infectious corneal blindness in all developed countries?

Answer 1

Herpes Simplex Virus

Question 2

Is Herpes Simplex usually unilateral or bilateral?

Answer 2

Unilateral (Almost always)

Question 3

Is type 1 or type 2 herpes simplex most associated with ocular diagnoses?

Answer 3

Type 1 (Type 2 genital/sexual transmitted)

Question 4

Who are the most common patients for primary herpes simplex?

Answer 4

School-aged children

Question 5

In primary herpes simplex, are symptoms common or uncommon?

Answer 5

Uncommon, 94% patients are asymptomatic.

Question 6

What are 4 ocular signs of primary herpes simplex-1?

Answer 6

1) Pre-auricular node swelling
2) Vesicular rash
3) Follicular conjunctivitis
4) (rare) multiple corneal punctate lesions (dendrite)

Question 7

What layer of the cornea will you find primary HSV-1 vesicles?

Answer 7

Epithelium

Question 8

True or false:
you can have ocular involvement with primary HSV-1.

Answer 8

True but it is very rare

Question 9

Where does HSV-1 get stored when it is latent?

Answer 9

Trigeminal and dorsal root ganglion

Question 10

What do you call recurrent HSV-1when it has ocular involvement?

Answer 10

Herpes Simplex Keratitis

Question 11

What symptoms will a patient have with Herpes Simplex Keratitis? (6)

Answer 11

Pain/ocular discomfort
Photophobia
Watering
Itching
Decreased vision/ blurry vision
Corneal Desensitization

Question 12

What main sign will signify Herpes Simplex Keratitis?

Answer 12

Dendritic Keratitis

Question 13

What are the 3 different types of Herpes Simplex Keratitis (HSK)? What is most common?

Answer 13

1) HSK- epithelial (most common)
2) HSK-Stromal
3) Endotheliitis

Question 14

What can you use to stain Herpes Simplex Keratitis (HSK)?

Answer 14

Fluorescein (center)
Lissamine green and Rose bengal (edges)

Question 15

What can you use to stain Herpes Simplex Keratitis (HSK)?

Answer 15

Fluorescein (center)
Lissamine green and Rose bengal (edges)

Question 16

Who are more susceptible to getting HSK-epithelial: Geographic keratitis?

Answer 16

Immune compromised
Misdiagnosed (receive steroid and come back later only to find it has spread larger)

Question 17

Describe HSK-Epithelial: Neurotrophic Keratits

Answer 17

Vision threatening
stromal involvement erodes epithelium
smooth round border
rapid progression
patient desensitized (false sense of getting better)

Question 18

Is stromal keratitis necrotizing or non-necrotizing? When does it occur?

Answer 18

Non-necrotizing
Occurs after HSK epithelial

Question 19

What kind of keratitis is HSV stromal that is necrotizing?

Answer 19

Interstitial keratitis

Question 20

What is HSK-endothelial: Endotheliitis typically in tandem with? What sign is found with this diagnoses?

Answer 20

Usually in tandem with Disciform
Endothelial folds/edema often found

Question 21

What HSK is more likely to require a corneal transplant?

Answer 21

HSK-endothelial: Endotheliitis

Question 22

What are 2 HSK complications?

Answer 22

-Corneal desensitization (hypoesthesia) especially in stroma
-Corneal scarring
-uveitis
-scleritis more often than episcleritis retinitis
optic neuritis