VIRAL KERATITIS

HERPES SIMPLEX KERATITIS

• Infection with herpes simplex virus (HSV) is most common
• HSV1 and HSV2 are 2 types of HSV Virus
• HSV1 causes infection above waist
• Following primary infection ,the virus travels up to trigeminal ganglion
and lies there in a latent stage
• There is a chance of recurrence while the virus travels down along
the sensory nerve to its target tissue.
 PRIMARY HERPECTIC KERATITIS

• Typically occurs b/w 6months to 5 yrs of age

• Typical lesion is an acute follicular conjunctivitis
• Fine epithelial keratitis may be present which may progress to
dendritic figure
• Vesicular eruptions and edema of lids
 RECURRENT HSV KERATITIS

DENDRITIC KERATITIS
SYMPTOMS
• Acute pain ,redness, lacrimation
• Photophobia , and blurring of vision
SIGNS
• Circumciliary congestion
• Superficial punctate keratitis ( whitish plaque of epithelial keratitis ) and later
desquamated to form erosions
• Formation of dendritic ulcer - erosions coalesce with each other and spread
in all directions and send out lateral branches with knobbed ends to form
dendritic / tree like
• Corneal sensation is diminished or absent
 GEOGRAPHICAL KERATITIS
• larger epithelial lesions with typical geographical / amoeboid
configuration
• Occurs as a continued enlargement of dendritic ulcer
• Likely to occur following inappropriate use of topical steroids
 TREATMENT
• Debridement of ulcer
• Antiviral agents – Acyclovir eye ointment 5 times for 14 days
( prolong use- superficial punctate keratopathy)
• Oral acyclovir 1 tab 4 times for 10 to 15 days
• Atropine eye drop 2 to 3 times
• Improvement of general health
• Cryocautery or iodine cautery of ulcer in resistance case
 HERPES ZOSTER OPHTHALMICUS
• Common infection caused by varicella zoster virus
• Mainly affects elderly patients
• Common in immunocompromised hosts

PATHOGENESIS
• After initial exposure the virus remains latent in trigeminal ganglion
• Under stress ,it becomes reactivated, replicated, and migrates down
the ophthalmic division of trigeminal nerve to develop ocular
complications
 SYMPTOMS
• Vesicular eruptions around eye , forehead, scalp
• Severe pain along the distribution of ophthalmic division of 5t nerve
• Photophobia and lacrimation

SIGNS
There are 3 stages
Stage 1 – acute lesions- which develop with in 3 weeks
Stage 2- chronic lesions- may persist for up to 10 yrs
Stage 3- recurrent lesions- which may reappear after 10 yrs
ACUTE OCULAR LESIONS
Lids : Redness, edema, and vesicular eruptions
Conjunctiva : acute mucopurulent conjunctivitis
Sclera: episcleritis and scleritis
Cornea : punctate epithelial keratitis
micro dendritis
CHRONIC OCULAR LESIONS
• Ptosis, trichiasis
• Scleritis
• Nummular keratitis ( coin shaped)
RECURRENT OCULAR LESIONS
• Episcleritis
• Scleritis
• Iritis
• glaucoma
 TREATMENT
• Oral acyclovir ; -800mg 5times daily for 7days
• Strong analgesics for pain reliving
• Antibiotics corticosteroid preparations
• Topical antibiotics
• Cycloplegics for iritis
• Artificial tears and bandage contact lens(persistent epithelial defect)
• Penetrating keratoplasty - dense scarring of cornea