Herpes simplex keratitis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*Epithelial disease | |||
**Infectious epithelial keratitis | |||
***Corneal vesicles rarely seen; dendritic ulcers form from coalesced corneal vesicles | |||
***Enlarge into geographic ulcers, with scalloped borders | |||
**Neurotrophic keratopathy | |||
***Ulcers more oval, with smooth borders as opposed to geographic ulcers | |||
***Irregular corneal surface from immune response | |||
***Decreased corneal sensitivity due to scarring, necrosis | |||
*Stromal keratitis - develops secondarily to in 25% of pts with epithelial disease | |||
**Necrotizing stromal keratitis - leads to thinning and perforation | |||
**Immune stromal keratitis - recurrent ocular HSV | |||
*Endotheliitis (disease extending from epithelium to stroma to endothelium) | |||
**Keratic precipitates | |||
**Accompanying iritis | |||
==Management== | ==Management== | ||
Revision as of 18:29, 29 December 2015
Background
- Most common cause of corneal blindness in US
- Avoid topical steroids to prevent necrotizing stromal keratitis
Clinical Features
- Blurred vision
- Pain, photophobia
- Tearing
- Perilimbic injection
- Normal pupil size and intraocular pressure
- Dendritic ulcers with fluorescein
Differential Diagnosis
Herpes Simplex Virus-1
- Eczema herpeticum
- Herpes gingivostomatitis
- Herpes keratitis
- Herpes labialis (cold sore)
- Herpes simplex encephalitis
- Herpetic whitlow
Diagnosis
- Epithelial disease
- Infectious epithelial keratitis
- Corneal vesicles rarely seen; dendritic ulcers form from coalesced corneal vesicles
- Enlarge into geographic ulcers, with scalloped borders
- Neurotrophic keratopathy
- Ulcers more oval, with smooth borders as opposed to geographic ulcers
- Irregular corneal surface from immune response
- Decreased corneal sensitivity due to scarring, necrosis
- Infectious epithelial keratitis
- Stromal keratitis - develops secondarily to in 25% of pts with epithelial disease
- Necrotizing stromal keratitis - leads to thinning and perforation
- Immune stromal keratitis - recurrent ocular HSV
- Endotheliitis (disease extending from epithelium to stroma to endothelium)
- Keratic precipitates
- Accompanying iritis
Management
Disposition
See Also
External Links
References
- Wang, J et al. Herpes Simplex Keratitis. Dec 7 2015. http://emedicine.medscape.com/article/1194268-overview#showall