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    Herpes Simplex Keratitis

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    riskhapangestika
    Herpes Simplex Keratitis is a common and serious eye infection caused by the Herpes Simplex Virus (HSV). It occurs when the dormant virus reactivates from sensory ganglia and infects the cornea. Clinical presentations include conjunctivitis, punctate epithelial lesions, dendritic ulcers, geographic ulcers, stromal keratitis, and endotheliitis. Treatment involves antiviral ointments, cycloplegics, and occasionally systemic antivirals. Steroids are only used for immune-mediated disciform keratitis and endotheliitis to avoid worsening the infection. Surgery may be needed for severe cases involving corneal scarring. Recognizing the various presentations is important for proper

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    Herpes Simplex Keratitis

    Uploaded by

    riskhapangestika
    267 views20 pages
    Herpes Simplex Keratitis is a common and serious eye infection caused by the Herpes Simplex Virus (HSV). It occurs when the dormant virus reactivates from sensory ganglia and infects the cornea. Clinical presentations include conjunctivitis, punctate epithelial lesions, dendritic ulcers, geographic ulcers, stromal keratitis, and endotheliitis. Treatment involves antiviral ointments, cycloplegics, and occasionally systemic antivirals. Steroids are only used for immune-mediated disciform keratitis and endotheliitis to avoid worsening the infection. Surgery may be needed for severe cases involving corneal scarring. Recognizing the various presentations is important for proper

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    Herpes Simplex Keratitis is a common and serious eye infection caused by the Herpes Simplex Virus (HSV). It occurs when the dormant virus reactivates from sensory ganglia and infects the cornea. Clinical presentations include conjunctivitis, punctate epithelial lesions, dendritic ulcers, geographic ulcers, stromal keratitis, and endotheliitis. Treatment involves antiviral ointments, cycloplegics, and occasionally systemic antivirals. Steroids are only used for immune-mediated disciform keratitis and endotheliitis to avoid worsening the infection. Surgery may be needed for severe cases involving corneal scarring. Recognizing the various presentations is important for proper

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    267 views20 pages

    Herpes Simplex Keratitis

    Uploaded by

    riskhapangestika
    Herpes Simplex Keratitis is a common and serious eye infection caused by the Herpes Simplex Virus (HSV). It occurs when the dormant virus reactivates from sensory ganglia and infects the cornea. Clinical presentations include conjunctivitis, punctate epithelial lesions, dendritic ulcers, geographic ulcers, stromal keratitis, and endotheliitis. Treatment involves antiviral ointments, cycloplegics, and occasionally systemic antivirals. Steroids are only used for immune-mediated disciform keratitis and endotheliitis to avoid worsening the infection. Surgery may be needed for severe cases involving corneal scarring. Recognizing the various presentations is important for proper

    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    of 20

    Herpes Simplex Keratitis

    Fatma Asyari MBBS, SpM(K)


    INOIIS , AINI

    CME ophth Sby July 21 2019 1


    Herpes Simplex
    Keratitis
    • Common , serious, recurrent
    • Caused by HSV1
    • Primary infection affecting mm , muco- cutaneous
    junction
    • Dormant state in trigeminal ganglion
    • Reactivation to skin , kornea
    • Various clinical presentations

    CME ophth Sby July 21 2019 2


    Primary HS infection
    Cold sore or fever blisters at
    mucocutaneous junction / aphtous

    CME ophth Sby July 21 2019 3


    Clinical presentations of HSV infections

    • Herpes simplex conjunctivitis


    • Keratitis punctata superficialis KPS
    • Dendritic keratitis
    • Amoeboid / Geographic ulcer
    • Stromal /disciform keratitis
    • Endothelitis
    • Trabeculitis
    • Herpes simplex Uveitis

    CME ophth Sby July 21 2019 4


    Viral conjunctivitis
    • Adenovirus, enterovirus, herpes virus
    • Acute
    • Uni/bilateral
    • Contagious
    • Watering
    • No itchy
    • Pre-auricular lymphadenopathy
    • Hemorrhage ( AHC )
    • Pseudo-membrane ( in children )
    • Filaments
    • Fever , flue
    CME ophth Sby July 21 2019 5
    Viral conjunctivitis
    Adenovirus
    enterovirus
    herpes virus

    Follicles
    pseudomembrane

    CME ophth Sby July 21 2019 6


    Viral conjunctivitis

    filaments

    pseudomembrane

    CME ophth Sby July 21 2019 7


    Bacterial conjunctivitis
    Staphylococcal infection

    N. gonorrhoea
    Profuse purulent discharge
    corneal perforation CME ophth Sby July 21 2019 8
    Epithelial Keratitis

    Initially punctate
    lesions
    Sub-epithelial infiltrate
    CME ophth Sby July 21 2019 9
    KPS DD/ epitheliopathy

    CME ophth Sby July 21 2019 10


    Dendritic keratitis
    Characteristic lesion

    • reactivation of a latent virus


    • Initially punctate lesions, coalescing
    into dendritiform pattern
    • reduced corneal sensitivity
    CME ophth Sby July 21 2019 11
    Geographic ulcer
    dendritic ---------> ‘amoeboid’ or ‘geographic’ ulcer (
    inappropriate steroids use )

    • Flat edge , stained with rose bengal


    • change shape due to continued viral progression
    • Viral cultures will be positive
    CME ophth Sby July 21 2019 12
    Necrotizing / Stromal ulceration

    • active viral replication


    • Decreased corneal
    sensation
    • Minimal infiltrate ,
    relatively transparent
    • hypopyon,
    • Complication :
    uveitis, glaucoma,
    cataract, retrocorneal
    membrane, rarely
    perforation
    CME ophth Sby July 21 2019 13
    Indolent Ulcer / Metaherpetic keratitis

    Rolled -in edge


    Persistent epithelial defect
    Delayed healing
    CME ophth Sby July 21 2019 14
    Disciform Keratitis / Endotheliitis

    • disc-shaped stromal edema, descemet’s folds


    • without infiltration or vascularization
    • Diffuse, central, or eccentric
    CME ophth Sby July 21 2019 15
    Endotheliitis
    •

    corneal edema, keratic precipitates,


    and mild anterior chamber reaction,

    CME ophth Sby July 21 2019 16


    Treatment
    • Epithelial debridement
    • Gan/Acyclovir topical ointment 5dd
    • Cycloplegic : stromal keratitis , endothelitis , uveitis
    • Artificial tears as adjuvants, vit A gel
    • Systemic antiviral : when severe, immuno-
    compromised patients or in HZO infection
    • Steroids : in immunological reaction (depending on
    the severity of the infection)

    CME ophth Sby July 21 2019 17


    Surgery

    • Conjunctival flap in necrotizing stromal keratitis


    • Deep anterior lamellar keratoplasty (DALK) in
    recurrent keratitis with corneal scarring
    • Amniotic membrane transplantation (AMT)
    - helps epithelial lining formation in delayed
    healing , Persistent Epithelial Defect PED
    - decreases stromal inflammation

    CME ophth Sby July 21 2019 18


    Message to be keep in mind

    • Recognize and keep in mind the various


    clinical presentation of HSV Keratitis
    • Never give steroids in epithelial infectious HSV
    infection except in disciform / endothelitis

    CME ophth Sby July 21 2019 19


    Thank you

    CME ophth Sby July 21 2019 20

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