Viral Keratitis Flashcards
Primary Infection of HSV
respiratory droplets
HSV in first 6 months
uncommon because of maternal antibodies
Recurrent Infections of HSV
reactivated by stressors
moves in peripheral nerves
Signs of HSV Keratitis
swollen/ opaque epithelial cells and punctate keratopathy leading to dendritic ulcers
decreased K sensation
mild subepithelial haze
Maybe: AC rxn, follicular conj, vesicular lid lesions, IOP increase
HSV Keratitis with steroids
geographic/ amoeboid appearance to ulcer
makes it worse
Tx for HSV Keratitis
anti-viral gel or tablets 5x a day
Aciclovir cream 5x a day for skin vesicles
debridement
Contraindications for HSV Keratitis
steroids prostaglandin derivates (IOP)
Prognosis for HSV Keratitis
ulcers normally heal in 2 weeks
subepithelial haze for weeks, increases with each recurrence
Signs of HSV Stromal Keratitis
stromal infiltration without ulceration
AC rxn
stromal scarring, thinning, vascularization
Tx for HSV Stromal Keratitis
topical steroids with antibiotic cover
Disciform Endotheliitis
Recurrent HSV, part of immune rxn
Symptoms of Disciform Endotheliitis
gradual blurring of vision with halos around light
Signs of Disciform Endotheliitis
stromal edema in circular pattern in central zone
underlying KPs
immune Wessely ring of deep stromal haze
Hx Related to Disciform Endotheliitis
decreased corneal sensitivity
Tx for Disciform Endotheliitis
topical steroids with antibiotic cover
Neurotrophic Keratopathy
associated with HSV
very low or no feeling in cornea from damaged nerves
decreases healing, leading to stromal scarring, corneal perforation, bacterial infection
Contraindications of Neurotrophic Keratopathy
antiviral drops- makes non-healing defects worse
Tx for Neurotrophic Keratopathy
lubricants
steroids for inflammation
Iridocyclitis
associated with HSV
acute trabeculitis that can cause rise in IOP
Tx for Iridocyclitis
steroids
Prophylaxis of HSV Keratitis Outbreak
400mg oral aciclovir
End result of severe HSV Keratitis
Keratoplasty
Herpes Zoster Ophthalmicus
shingles involving ophthalmic division of trigeminal nerve
Hutchinson Sign
trademark sign of HZO
if nose is involved, eye likely is too
Tx for Shingles
oral antivirals- 800mg aciclovir 5x day for 5-7 days
Signs of HZO
dendritic ulcers- smaller/ finer than HSV, self resolve stromal keratitis- scar anterior uveitis- elevates IOP disciform keratitis posterior uveitis- PRN/ ARN
Long Term Effects of HZO
neurotrophic keratitis
scleritis
lid scarring
post herpetic neuralgia
When to do corneal sensitivity testing
unilateral red eye
