HERPES SIMPLEX KERATITIS

  • A kind of keratitis due to recurrent herpes simplex virus (HSV) infection in the cornea.
    • Starts with infection of epithelial cells on the surface of the eye and backward infection of corneal nerves.
    • Blepharoconjunctivitis: primary infection that manifests as conjunctival swelling and eyelids with small, white itchy wounds on the surface of the cornea.
      • Lesion effects are varied, from little damage to the epithelium (superficial punctate keratitis) to dendritic ulcer formation.
      • It affects one eye at a time.
    • Recurrent episodes may be worse, showing development of larger dendritic ulcers and white plaque formation on lesion sites.
      • There is removal of epithelial layers and mild inflammation (iritis) may also happen. Loss of sensation may occur. Recurrence can be joined by chronic dry eye, low grade intermittent conjunctivitis, or chronic unexplained sinusitis.
    • Very common in humans and is stated as the most common cause of cornea-derived blindness in developed nations.
    • Other names: herpetic keratoconjunctivitis, herpes viral keratitis.

Primary infection (herpetic blepharitis)

  • Is seen as blepharo conjunctivitis i.e. lid and conjunctival infection that heals without scarring. Corneal involvement is rare.

Recurrent eye infection

  • Due to virus reactivation in a latent infected sensory ganglion, transport of the virus to sensory nerve endings, and subsequent infection of ocular surface.
  • The following classification of herpes simplex keratitis is important for understanding this disease:
    • Dendritic ulcer (Epithelial keratitis)
      • A classic lesion consisting of a linear branching corneal ulcer (dendritic ulcer). The underlying cornea has little inflammation.
      • Symptoms of foreign-body sensation, light sensitivity, redness and blurred vision.
      • Local or diffuse reduction in corneal sensation develops following recurrent epithelial keratitis.
    • Disciform keratitis (Stromal keratitis)
      • Is seen as a disc-shaped area of corneal edema. Longstanding edema leads to permanent scarring and is the major cause of decreased vision connected with herpes.
      • Caused by Localized endothelitis, the localized inflammation of corneal endothelial layer.
    • Other forms
      • Metaherpetic ulcer results from inability of the corneal surface to heal.
      • Necrotizing keratitis.
      • Keratouveitis: granulomatous uveitis with large keratic deposits on the corneal endothelium.

DIAGNOSIS

  • Physician may do/request:
    • History & Physical Exam
    • Lab tests (Smears, serology, DNA testing)

 

RECOMMENDED MEDICATION

  • Symptomatic therapy

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