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Herpes simplex keratitis
From WikEM
(Redirected from HSV Conjunctivitis)
Contents
Background
- Also known as herpetic keratoconjunctivitis and herpesviral keratitis
- Conjunctivitis alone or may involve cornea, eyelids, and skin
- Higher rate in HIV patients
- Stress, fever, trauma, or UV light can trigger reactivation
- Severe cases may cause uveitis, iritis, and increased intraocular pressure
Clinical Features
- Usually unilateral with palpable preauricular node
- More pain than usual conjunctivitis
- Foreign body sensation
Differential Diagnosis
Conjunctivitis Types
- Viral conjunctivitis
- Epidemic keratoconjunctivitis
- Herpes zoster ophthalmicus
- Herpes simplex keratitis
- Bacterial conjunctivitis
- Allergic conjunctivitis
- Caustic keratoconjunctivitis
Evaluation
Workup
- Slit-lamp with fluorescein
- Must evaluate for corneal involvement (keratitis)
- Slit-lamp fluorescein findings: Pinpoint or dendritic lesions
Diagnosis
Severe
- Any of the following:
- Skin involvement (e.g. eyelids)
- Photophobia
- Decreased vision
- Corneal lesion
- Flare in ant chamber
Management and Disposition
Do not give steroids
Mild
- Cool compresses
- Trifluridine 1% drops 5x per day x 10-14d
- Follow-up ophtho 2-5d to monitor for corneal involvement
Severe
- Trifluridine 1% drops 9x per day x 7-10d AND
- Oral acyclovir 400mg PO 5x per day x 7-10d
- Consider cycloplegic agent if flare in anterior chamber
- Scopolamine 0.25% TID
- Follow-up with ophtho within 2d
See Also
References
- Mahmood, Narang. Diagnosis and management of acute red eye. Emerg Med Clin N Am. 2008;26
