JENAN GHAI TH

Herpetic Keratitis
Pathogenesis
HSV-1
Transmitted via direct contact, or infected fluid secretions
Ocular infection is usually recurrent, not primary
Documented triggers: immunosuppressant, topical drops (esp
steroids), UV laser treatment.
Epidemiology
Most are exposed by middle age (high risk: contact sports and
HCW)
Incidence: 12-31 per 100,000 annually
Prevalence: 150 per 100,000 annually


Herpes Simplex Keratitis
Clinical Presentation
Symptoms : Acute onset; pain, blurred vision, watery
discharge, photophobia.
Sign: fluorescein staining maybe subtle, or dendritic
lesions.
Usually clinical diagnosis, rarely need lab test
Many types: Dendritic, Geographic ulcer, Marginal
Keratitis, HSV stromal keratitis, Endothelitiitis,
neurotrophic keratopathy, HSV keratouvenitis.
DDX: drug keratopathy, parasitic keratitis, bacterial
keratitis, inflammatory keratitis, trauma
Appropriate Clinical Exams/Investigations
Clinical exams
Chemosis, conjunctivitis,
Dendritic lesions, corneal
ulcer, decrease sensation
on cornea, blindness
Laboratory
investigations
Corneal scrape HSV PCR,
rarely done
Treatment
Acyclovir 3% eye ointment
5x/daily for 2-3weeks
NEVER USE STEROID ALONE
Prognosis
A common cause of blindness, if
stroma is affected
Uveitis and glaucoma can
accompany HSV keratitis as well
Pathogenesis
Transmitted via aerosol droplets. Herpes Zoster primary
infection travels retrograde through nerve axons to Gasserian
ganglion till reactivated again,
Triggers: immunosuppression, Autoimmune disease, physical
trauma, HIV

Epidemiology
Most common in elderly >50 yr old
50-70% have ocular involvement in first division of 5
th
CN


Herpes Zoster Opthalmicus
Clinical Presentation
Symptoms : prodromal: headache, malaise, fever,
followed by unilateral pain or hypoesthesia, and
vesicular, blistering rash, red eye, decreased vision,
pain
Sign: (Hutchinsons sign!!), lid swelling, iritis, 2ndry
glaucoma
Usually clinical diagnosis, rarely need lab test
DDX: drug keratopathy, parasitic keratitis, bacterial
keratitis, inflammatory keratitis, trauma
Appropriate Clinical Exams/Investigations
Clinical exams
Perauricular
lymphadenopathy,
vesicular rash in
ophthalmic nerve region,
orbital edema, glaucoma,
iritis
Laboratory
investigations
Corneal scrape HZV PCR,
rarely done
Treatment
Eye disease: Acyclovir 3% eye
ointment 5x/daily for 2-3weeks
Oral acyclovir within 3 days of
vesicles eruption for post-
infective neuralgia.
Prognosis
Cataract, glaucoma, and macular
edema are common, meningitis,
and blindness.
Summary


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