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Herpes Simplex Dendritic Keratitis

Dendritic Keratitis due to Herpes Simplex


Presentation

  • We present two patients treated with latanoprost for primary open angle glaucoma who developed herpes keratitis.[bjo.bmj.com]
  • Ocular involvement may be the earliest presenting manifestation of this disease. Early diagnosis is essential because dietary modifications can result in complete reversal of the manifestations of this disorder.[ncbi.nlm.nih.gov]
Corneal Edema
  • Corneal edema after SLT treatment has been reported before, but the etiology has been unclear.[readbyqxmd.com]
  • Disciform keratitis is a deeper, disc-shaped, localized area of secondary corneal edema and haze accompanied by anterior uveitis. This form may cause pain and reversible vision loss.[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]
  • Although keratic precipitates are often present, they may be difficult to see due to the corneal edema.[eyerounds.org]
  • Longstanding corneal edema leads to permanent scarring and is the major cause of decreased vision associated with HSV. Localized endothelitis (localized inflammation of corneal endothelial layer) is the cause of disciform keratitis.[en.wikipedia.org]
Foreign Body Sensation
  • body sensation, and pain in the eye. 1 There are reports that latanoprost has almost no serious side effects.[bjo.bmj.com]
  • If the cornea is involved, early symptoms include foreign body sensation, lacrimation, photophobia, and conjunctival hyperemia.[merckmanuals.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]
  • Patients with epithelial keratitis complain of foreign-body sensation, light sensitivity, redness and blurred vision. Focal or diffuse reduction in corneal sensation develops following recurrent epithelial keratitis.[en.wikipedia.org]
  • 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]
Red Eye
  • Another eye dx comparison chart red eye DDx eye anatomy chart as a 'study method' for anatomy and physiology class. The Cranial Nerves (Organization of the Central Nervous System) Part 3 Mehr Strabismus (misaligned eyes) Special for YOU![pinterest.co.uk]
  • […] drops,refresh eye drops,cyclogyl drops,.i was improved by 7th day and my corneal stain had become nil by then.since there was corneal opacity,i was put on steroid drops and oral steroid.i was feeling okay for three days and once again the symtoms of red[drugs.com]
  • These patients typically present with a painful, red eye with photophobia. The HSV is typically the type-1 hsv infection that most people are inoculated with (HSV1 is the cause of cold-sores) and is thus not a sexual infection.[timroot.com]
  • Other conditions causing red eye. Orbital cellulitis. Investigations [ 1 ] Most cases will be confirmed clinically and do not require further investigation following ophthalmological review.[patient.info]
  • Contact lens acute red eye (CLARE) — a non-ulcerative sterile keratitis associated with colonization of Gram-negative bacteria on contact lenses. Treatment [ edit ] Treatment depends on the cause of the keratitis.[en.wikipedia.org]
Excessive Tearing
  • 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]
  • Blurring from excess tears and loss of vision can be expected at this point.[medicalook.com]
  • 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 by a fulminant course ; with severe ulceration[amboss.com]
Indecisiveness
  • For example, a suspected link between psychological stress and herpetic keratitis remains indecisive ( HEDS Group 2000a ; Kip 2001 ).[doi.org]

Workup

  • (See Workup.) Patient education For patient education information, see the Eye and Vision Center, as well as Corneal Ulcer.[emedicine.medscape.com]

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]
  • Selection bias was evaluated by examining randomisation of treatment allocation and concealment of assigned treatment group.[doi.org]

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]
  • […] 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]
  • Corneal edema after SLT treatment has been reported before, but the etiology has been unclear.[readbyqxmd.com]

Epidemiology

  • Epidemiology: Most frequent cause of corneal blindness in the United States Most common source of infectious blindness in the Western world.[coreem.net]
  • Herpes simplex virus epidemiology and ocular importance. Cornea. 2001;20:1–13. 2. Holland EJ, Schwartz GS, Neff KD. Herpes simplex keratitis. In: Krachmer JH, Mannis MJ, Holland EJ, editors. Cornea. Philadelphia, PA: Elsevier Mosby; 2011:953–984. 3.[dovepress.com]
  • 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]
Sex distribution
Age distribution

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

  • 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]
  • By the median test, this difference in healing times was statistically significant (p 0.035), and the combination prevented cases of prolonged ulceration.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • A controlled trial of oral acyclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis. Arch Ophthalmol. 1997;115:703-712. The Herpetic Eye Disease Study Group.[glaucomatoday.com]

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