Presentation
We present two patients treated with latanoprost for primary open angle glaucoma who developed herpes keratitis. [bjo.bmj.com]
They heal without scarring and cross dermatomes (usually localised to the eyelids when present, and be present bilateral). [lifeinthefastlane.com]
In advanced cases, microcystic epithelial edema may be present as well. Although keratic precipitates are often present, they may be difficult to see due to the corneal edema. [eyerounds.org]
"It can present as a keratitis. It can be very large, it can be very tiny, and therein lies the difficulty. It can present in someone who doesn't have a history of diagnosed herpes simplex." True HSV also progresses in stages, said Clara C. [eyeworld.org]
CONCLUSIONS: We report a rare presentation of varicella. [readbyqxmd.com]
Eyes
- Corneal Edema
Corneal edema after SLT treatment has been reported before, but the etiology has been unclear. [readbyqxmd.com]
Characteristic findings include a branching dendritic or serpentine corneal lesion (indicating dendritic keratitis) or disc-shaped, localized corneal edema and haze plus anterior uveitis (indicating disciform keratitis). [merckmanuals.com]
Three weeks later, the dendrite had resolved and the corneal edema was greatly improved, with central corneal thickness decreased to 550 µp?. [healio.com]
Disciform HSV keratitis with central corneal edema, keratic precipitates and microcystic edema Figure 6 (A and B). [eyerounds.org]
Disciform endotheliitis appear as round patches of central or paracentral corneal edema with a clear demarcation between involved and uninvolved cornea. [decisionmakerplus.net]
- Foreign Body Sensation
If the cornea is involved, early symptoms include foreign body sensation, lacrimation, photophobia, and conjunctival hyperemia. [merckmanuals.com]
body sensation, and pain in the eye. 1 There are reports that latanoprost has almost no serious side effects. [bjo.bmj.com]
body sensation Purulent discharge Photophobia Excessive tearing Blurry vision Eye redness Conjunctival injection Special form: Pseudomonas keratitis Caused by: Pseudomonas aeruginosa Most common cause of bacterial keratitis in contact lens users Characterized [amboss.com]
Answer and interpretation History: Painful red eye, altered vision, foreign body sensation, photophobia, tearing; usually unilateral Skin (e.g., eyelid) vesicular rash may be present History of previous episodes of HSV (nasal, oral or ocular) Triggers [lifeinthefastlane.com]
Signs & Symptoms of Herpes Keratitis The following signs and symptoms occur in only one eye in a herpes simplex keratitis infection: Photophobia – light sensitivity Excessive Tearing/watery eyes Irritation and gritty feeling Eyelid swelling Foreign body [mastereyeassociates.com]
- Conjunctival Injection
[…] vessel injection Treatment : Patient briefing Antibiotic eye ointment Immobilization Oral analgesics Course : Usually complete recovery after 24–48 h Risk of infection Anesthetic eye drops should only be applied for diagnostic purposes! [amboss.com]
In addition, there may be mild conjunctival injection, ciliary flush, mild stromal edema and subpeithelial white blood cell infiltration. [eyewiki.aao.org]
Involvement here is less common in secondary infection although conjunctival injection (red eye) is almost universal. There may be erosions around the lid margin with the presence of small vesicles or pustules. [patient.info]
injection OD without papillary or follicular reaction OS: Normal Cornea: (Figure 1) OD: Four small dendritic epithelial defects in the visual axis; no evidence of basement membrane dystrophy; clear and compact stroma without vascularization; no perineuritis [eyerounds.org]
- Excessive Tearing
Blurring from excess tears and loss of vision can be expected at this point. [medicalook.com]
Signs & Symptoms of Herpes Keratitis The following signs and symptoms occur in only one eye in a herpes simplex keratitis infection: Photophobia – light sensitivity Excessive Tearing/watery eyes Irritation and gritty feeling Eyelid swelling Foreign body [mastereyeassociates.com]
[…] aeruginosa Syphilis Enterobacteriaceae (including Klebsiella ) Risk factors Contact lens use Recent eye surgery or injury Immunodeficiency Lacrimal duct stenosis Clinical features Progressive pain Foreign body sensation Purulent discharge Photophobia Excessive [amboss.com]
Workup
(See Workup.) Patient education For patient education information, see the Eye and Vision Center, as well as Corneal Ulcer. [emedicine.medscape.com]
The parents were advised to have a biochemistry workup for inherited metabolic diseases and also have a pediatric evaluation. Urine metabolic screen and plasma amino acid profile were done. [ijo.in]
Treatment
METHODS: Both treatment modalities were administered on a five times daily basis to patients suffering from herpes simplex keratitis. Patients were assigned randomly to one of the two treatment groups for the purpose of the trial. [ncbi.nlm.nih.gov]
After antiviral treatment, trabeculectomy was carried out in the right eye, when latanoprost treatment was continued in the left eye. [bjo.bmj.com]
Drug treatments Pascal 002 Biological and medical sciences / 002B Medical sciences / 002B09 Ophthalmology Discipline General pharmacology Ophthalmology Origin Inist-CNRS Database PASCAL INIST identifier PASCAL8050073014 Sauf mention contraire ci-dessus [pascal-francis.inist.fr]
Selection bias was evaluated by examining randomisation of treatment allocation and concealment of assigned treatment group. [cochranelibrary.com]
Prognosis
The prognosis in HSV keratitis, however, is generally favorable with aggressive treatment. [emedicine.medscape.com]
Prognosis Prognosis is usually good, but greatly varies depending on severity and number of recurrences of the disease. [eyewiki.aao.org]
Comparison of rubella virus- and herpes virus-associated anterior uveitis: clinical manifestations and visual prognosis. Ophthalmology. 2011;118:1905-1910. Sungur G, Hazirolan D, Yalvac I, et al. [glaucomatoday.com]
Application of steroids to a dendritic ulcer caused by HSV will result in rapid and significant worsening of the ulcer to form an 'amoeboid' or 'geographic' ulcer, so named because of the ulcer's map like shape. [ citation needed ] Prognosis [ edit ] [en.wikipedia.org]
Prognosis [ 1, 8 ] Eyelid lesions and conjunctival disease alone tend to resolve over two weeks. [patient.info]
Etiology
Overview Bacterial keratitis Epidemiology : most common form of keratitis ( ∼ 90% ) Etiology Mainly: staphylococci ( Staphylococcus aureus ), streptococci ( Streptococcus pneumoniae ), Pseudomonas aeruginosa Syphilis Enterobacteriaceae (including Klebsiella [amboss.com]
(See Pathophysiology, Etiology, and Presentation.) Although more common as a manifestation of recurrent HSV infection, HSV keratitis may also be seen during a primary HSV infection. (See Workup.) [emedicine.medscape.com]
When scarring is also absent, however, it does not rule out the possibility of stromal HSV as the underlying etiology. [reviewofcontactlenses.com]
Corneal edema after SLT treatment has been reported before, but the etiology has been unclear. [readbyqxmd.com]
[…] is congenital syphilis Less common etiologies is from acquired syphilis, tuberculosis, Cogan’s syndrome, Lyme disease and Herpes simplex virus, so it has to be considered as a differential diagnosis The critical sign for interstitial keratitis is the [decisionmakerplus.net]
Epidemiology
Epidemiology: Most frequent cause of corneal blindness in the United States Most common source of infectious blindness in the Western world. [coreem.net]
Overview Bacterial keratitis Epidemiology : most common form of keratitis ( ∼ 90% ) Etiology Mainly: staphylococci ( Staphylococcus aureus ), streptococci ( Streptococcus pneumoniae ), Pseudomonas aeruginosa Syphilis Enterobacteriaceae (including Klebsiella [amboss.com]
Herpes simplex epithelial and stromal keratitis: an epidemiologic update. Surv Ophthalmol. 2012;57:448-462. 2. Weiner G. Demystifying the ocular herpes simplex virus. American Academy of Ophthalmology. [uspharmacist.com]
Herpes simplex epithelial and stromal keratitis: an epidemiologic update. Surv Ophthalmol. 2012;57:448-62. 2. Holland EJ, Brilakis HS, Schwartz GS. Herpes simplex keratitis. In: Krachmer JH, Mannis MJ, Holland EJ, eds. Cornea. 2nd ed. St. [reviewofcontactlenses.com]
Epidemiology Annual incidence: new cases 13 per 100,000, and recurrent infection 18 per 100.000. [ 2 ] Overall prevalence of ocular herpes simplex: 150 per 100,000. Male:female = 1:1. Peak initial presentation age: 37 years (average). [patient.info]
Pathophysiology
Approximately 2 million people worldwide have impaired vision from herpetic eye disease ( Farooq 2012 ) Pathophysiology: Primary infection: occurs most commonly in the mucocutaneous or ocular distribution of the trigeminal nerve, and can present as a [coreem.net]
Pathophysiology HSV is a DNA virus that commonly affects humans. Infection occurs by direct contact of skin or mucous membrane with virus-laden lesions or secretions. [emedicine.medscape.com]
[…] epithelial damage caused by severe UV light radiation with pronounced pain symptomatology Etiology Welding without proper protective eye wear Associated with cosmetic tanning (tanning bed) High levels of UV radiation in high-altitude mountain regions Pathophysiology [amboss.com]
Pathophysiology Add text here Primary prevention Prevention of herpetic infection includes avoidance of direct contact with known HSV. [eyewiki.aao.org]
Pathophysiology of Herpes Simplex Virus Keratitis Ocular HSV infection comprises several potentially vision-impairing conditions. [touchophthalmology.com]
Prevention
Recurrence of HSV Keratitis While there are no proven methods for preventing HSV keratitis, there are steps that can be taken to assist in controlling its recurrences. [uspharmacist.com]
Recurrences can be prevented There is now conclusive evidence that attacks can be prevented with the use of Aciclovir, see here (2003). [goodhopeeyeclinic.org.uk]
KERATITIS PREVENTION Preventing keratitis can be as simple as maintaining a well-balanced diet with an adequate amount of Vitamin A, or regularly taking Vitamin A supplements. [medicalook.com]
Currently there are no proven methods for preventing HSV keratitis, but some steps available from the Mayo Clinic External may help to control HSV keratitis recurrences: Avoid touching your eyes or the area around your eyes unless you have washed your [cdc.gov]
HOW TO PREVENT A RECURRENCE Sometimes herpes simplex keratitis seems to be cured only to recur months or even years later in the same spot just as cold sore keeps coming back on the lip. [eyeconx.net]