Herpes simplex keratitis

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

Herpes simplex keratitis

• 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
  • Gonorrheal conjunctivitis
  • Chlamydia 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

• Conjunctivitis
• HSV
• Eye Algorithm (Main)

References

• Mahmood, Narang. Diagnosis and management of acute red eye. Emerg Med Clin N Am. 2008;26

Authors

Ross Donaldson, Daniel Ostermayer, Jordan Swartz, Neil Young