Herpes simplex keratitis
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