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Herpes Simplex Keratoconjunctivitis

Herpetic Keratoconjunctivitis


Presentation

  • The disease most commonly presents as 1 of 3 clinical manifestations: disseminated visceral infection (with and without central nervous system involvement), isolated meningoencephalitis, and infection limited to the skin, eyes, and/or mucous membranes[ncbi.nlm.nih.gov]
  • Introduction Infection of the conjunctiva by HSV typically following vesicular eyelid eruption herpes labialis may or may not be present Corneal involvement is often precipitated by topical or systemic corticosteroid treatment Treatment Topical antivirals[medbullets.com]
  • Purpose: The purpose of this paper is to present a case of a Herpes simplex keratitis presenting as a case of acute corneal hydrops. Methods : Case report.[omicsonline.org]
  • 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]
  • PCR may be useful in the laboratory diagnosis of such an atypical presentation of HSK.[bmcophthalmol.biomedcentral.com]
Ascitic Fluid
  • الصفحة 147 - Tumor cells secrete a vascular permeability factor that promotes accumulation of ascites fluid. ‏ الصفحة 147 - Benjamin LE, Hemo I, Keshet E.[books.google.com]
Fishing
  • Past Ocular History: Contact lens; daily wear Myopia Past Medical History: Frequent herpetic "cold sores" Herpes genitalis Medications: Multivitamins and fish oil supplements Family History: Non-contributory Social History: Drinks alcohol occasionally[eyerounds.org]
Eruptions
  • Introduction Infection of the conjunctiva by HSV typically following vesicular eyelid eruption herpes labialis may or may not be present Corneal involvement is often precipitated by topical or systemic corticosteroid treatment Treatment Topical antivirals[medbullets.com]
  • Examination of the scalp revealed a diffuse hair loss and no drug eruptions [Figure 1]. The color and the texture of the hair were normal.[meajo.org]
  • Once the infection has been triggered, it may run its course and disappear, in much the same way that cold sores do, but the HS infection tends to recur; such recurrences are prone to complications, the most characteristic of which is a type of corneal eruption[waterdownoptometric.ca]
  • In primary HSV, there is usually a mixed follicular and papillary conjunctivitis, which may be accompanied by vesicular eruptions on the eyelids that progress to pustules. Dendritic ulcers are rarely associated with a primary HSV infection.[healio.com]
  • Major precipitating factors were: history of minor ocular trauma in 20%; fever in 15%; and exanthematous skin eruptions in 2.5% cases. Bilateral herpetic keratitis was seen in 15% of patients. The average age of the bilateral cases was 40 years.[ijo.in]
Macula
  • […] clear and compact stroma without vascularization; no perineuritis; no endothelial inflammation OS: Clear and compact with no evidence of basement membrane dystrophy Anterior chamber: Deep and quiet OU Lens: Clear OU Funduscopic examination: Normal disc, macula[eyerounds.org]
Red Eye
  • Iridocyclitis is a serious form of eye herpes where the iris and surrounding tissues inside the eye become inflamed, causing severe sensitivity to light, blurred vision, pain and red eyes.[allaboutvision.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]
  • […] 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]
  • MARAZZI/SCIENCE PHOTO LIBRARY Symptoms of a herpes simplex eye infection can include: a red eye eye pain swelling around the eye sensitivity to bright light a watering eye blurred vision Usually only one eye is affected, although sometimes both can be[nhs.uk]
  • It is important before treating a patient with combination medication such as antibiotics and steroids because of a red eye, to put fluorescein or other dye into the eye to make sure that there are no dendritic changes in the conjunctiva,’ he said.[eurotimes.org]
Lacrimation
  • In-depth information on ocular drugs used in clinical practice, including chapters on drugs used to treat eyelid disorders, lacrimal diseases, conjunctiva diseases, corneal diseases, allergies, uveitis, postoperative cataract, retinal diseases, and glaucoma[books.google.com]
  • Eye tear system anatomy, (Description) a. tear gland / lacrimal gland, b. superior lacrimal punctum, c. superior lacrimal canal, d. tear sac / lacrimal sac, e. inferior lacrimal punctum, f. inferior lacrimal canal, g. nasolacrimal canal.[emedicine.medscape.com]
  • If the cornea is involved, early symptoms include foreign body sensation, lacrimation, photophobia, and conjunctival hyperemia.[merckmanuals.com]
  • Etiology Mainly: staphylococci ( Staphylococcus aureus ), streptococci ( Streptococcus pneumoniae ), Pseudomonas aeruginosa Syphilis Enterobacteriaceae (including Klebsiella ) Risk factors Contact lens use Recent eye surgery or injury Immunodeficiency Lacrimal[amboss.com]
  • Pedersen B, Møller Andersen S, Klauber A et al (1982) Secretory IgA specific for herpes simplex virus in lacrimal fluid from patients with herpes keratitis—a possible diagnostic parameter. Br J Ophthalmol 66:648–653 CrossRef PubMed PubMedCentral 15.[springermedizin.de]
Eye Pain
  • Critical Essential Core Tested Community Questions (3) Sorry, this question is for PEAK Premium Subscribers only (M2.OP.14) A 22-year-old woman with no significant past medical history presents with right eye pain, blurry vision, and watery discharge.[medbullets.com]
  • Dendritic Lesions (optometrist.com.au) Symptoms: Eye pain Corneal injection Visual changes (blurry vision, decreased visual acuity) Tearing Discharge Photophobia Physical exam: Visual acuity should be performed in all patients Fluorescein staining May[coreem.net]
  • Eye pain, tearing, redness, a feeling like a foreign object is in the eye (foreign body sensation), and sensitivity to bright light are common symptoms.[merckmanuals.com]
  • MARAZZI/SCIENCE PHOTO LIBRARY Symptoms of a herpes simplex eye infection can include: a red eye eye pain swelling around the eye sensitivity to bright light a watering eye blurred vision Usually only one eye is affected, although sometimes both can be[nhs.uk]
Dry Eyes
  • Dry eye disease may be subdivided into 2 main types as follows: Dry eye disease unassociated with SS (non-SS KCS) Dry eye disease can also be subdivided into pure aqueous deficiency dry eye and evaporative dry eye. [3] Eighty-six percent of patients with[emedicine.medscape.com]
  • […] stroke Neurotrophic keratopathy Definition : keratitis as a result of corneal sensory loss due to paralysis of the 1 st trigeminal branch Etiology Nerve damage Tumor in the nerve path region Chronic herpes infection Clinical features Decreased vision; dry[amboss.com]
  • Sensation loss occurs in lesional areas, producing generalised corneal anaesthesia with repeated recurrences. [3] Recurrence can be accompanied by chronic dry eye, low grade intermittent conjunctivitis, or chronic unexplained sinusitis.[en.wikipedia.org]
Excessive Tearing
  • 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]
  • Signs and symptoms The following are the most common complaints associated with dry eye disease: Foreign-body sensation and ocular dryness and grittiness Hyperemia Mucoid discharge Ocular irritation Excessive tearing (secondary to reflex secretion) Photophobia[emedicine.medscape.com]
Suggestibility
  • Differentiation-related expression of a major 64K corneal keratin in vivo and in culture suggests limbal location of corneal epithelial stem cells. J Cell Biol 1986; 103:49-62. ‏ الصفحة 383 - Tyring S, Barbarash RA, Nahlik JE, et al.[books.google.com]
  • In two cases, lymphocytes were in close contact with affected keratocytes, suggesting that cell-mediated immunity plays a role in herpetic interstitial keratitis.[journals.lww.com]
  • As suggested in epidemiologic studies in the Euro-American countries, its recurrence rate could be up to 30% in the first year, and 46% in the second years.[clinicaltrials.gov]
  • Asked 26 Jul 2013 by s MIT Updated 22 May 2014 Topics cyclogyl , refresh , eye conditions , ocular herpes simplex , keratitis , herpes simplex , acyclovir , moxifloxacin , herpes simplex dendritic keratitis , herpes Details: ... ophthalmologist has suggested[drugs.com]
  • They suggest a potential link between corneal innervation and endothelial cell homeostasis.[iovs.arvojournals.org]
Neuralgia
  • Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia: a randomized, double-blind, placebo-controlled trial. ‏[books.google.com]
  • Herpes zoster can also cause scarring of the skin and permanent pain known as post herpetic neuralgia (PHN). Therefore, I frequently refer patients to see a dermatologist and or a pain management specialist.[houstoneyedoctorvital.com]
Neglect
  • In neglected cases, permanent endothelial cell injury and corneal decompensation may occur.[eyerounds.org]

Workup

  • (See Workup.) Patient education For patient education information, see the Eye and Vision Center, as well as Corneal Ulcer.[emedicine.medscape.com]
Multiple Ulcerations
  • Secondary HSV infection usually presents in the form of a small, single, dendritic corneal ulcer or multiple ulcers. These ulcers are thin, linear, branching lesions, often with terminal end bulbs.[healio.com]

Treatment

  • Introduction Infection of the conjunctiva by HSV typically following vesicular eyelid eruption herpes labialis may or may not be present Corneal involvement is often precipitated by topical or systemic corticosteroid treatment Treatment Topical antivirals[medbullets.com]
  • Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia: a randomized, double-blind, placebo-controlled trial. ‏[books.google.com]
  • Treatment • Topical steroid to control any inflammatory component should be kept to a minimum 18.[slideshare.net]
  • CO 17 The treatment treatment: Aciclovir or increasingly Ganciclovir cream The treatment is Virgan/gangcylovir 5 times a day till healed, then one drop 3 times a day for 1 week. With prompt treatment you get a 100% recovery.[goodhopeeyeclinic.org.uk]
  • […] potential in the treatment of a number of other ocular infections.[touchophthalmology.com]

Prognosis

  • The prognosis in HSV keratitis, however, is generally favorable with aggressive treatment.[emedicine.medscape.com]
  • In patients with herpetic keratitis whose corneas are minimally vascularised (thus with reduced risk of rejection) and in whom recurrence is prevented, the prognosis for maintaining a transparent graft in herpetic keratitis is good.[bjo.bmj.com]
  • Prognosis [ 1, 8 ] Eyelid lesions and conjunctival disease alone tend to resolve over two weeks.[patient.info]
  • Ficker L,Kirkness C,Rice N,et al.Changing management and improved prognosis for corneal grafting and herpes simplex keratitis.Ophthalmology. 1989;96(11):1587-1596.[crstodayeurope.com]

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]
  • The presence of multinucleated giant cells with characteristic nuclear morphology (molding), may suggest a viral etiology. It may be seen in infections caused by HSV- 1, HSV-2 and VZV.[bmcophthalmol.biomedcentral.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]
  • Bacterial and fungal cultures, along with confocal microscopy, can be used to rule out other etiologies of microbial keratitis.[eyerounds.org]

Epidemiology

  • Epidemiology: Most frequent cause of corneal blindness in the United States Most common source of infectious blindness in the Western world.[coreem.net]
  • Epidemiology of herpes simplex keratitis. Invest Ophthalmol Vis Sci 1963;2:498-503. [ PUBMED ] 15. Darougar S, Wishart MS, Viswalingam ND. Epidemiological and clinical features of primary herpes simplex virus ocular infection.[ijo.in]
  • As suggested in epidemiologic studies in the Euro-American countries, its recurrence rate could be up to 30% in the first year, and 46% in the second years.[clinicaltrials.gov]
  • 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]
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]
  • […] 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 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]
  • […] first year and 33% by the end of the second year.[4] Clinical Presentations HSV keratitis can present with involvement of the corneal epithelium, stroma, or endothelium, with or without associated inflammation of the anterior chamber (Table 1).[1-4] Pathophysiologic[eyerounds.org]

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]
  • Centers for Disease Control and Prevention. Genital Herpes - CDC Fact Sheet. Available online at . Page last reviewed September 6, 2012. Accessed January 2013. Centers for Disease Control and Prevention.[labtestsonline.it]
  • 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]
  • Acyclovir for the prevention of recurrent herpes simplex virus eye disease. The New England Journal of Medicine. July 1998.[allaboutvision.com]
  • The second objective is to prevent a reactivation of the immune processes associated with HSV immune stromal keratitis.[crstoday.com]

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