Conjunctiva

Herpes Simplex Keratitis

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Herpes Simplex Keratitis, Herpes Keratitis, Herpetic Keratitis, Herpes Simplex Conjunctivitis, HSV Conjunctivitis, Herpetic Dendrite, Dendritic Keratitis, Dendritic Ulcer

  • Epidemiology
  1. Outbreaks in winter and early summer
  • Symptoms
  1. Previous history of Herpes Keratitis
  2. Coexisting Fever Blister (herpetic rash) on lip or upper face
  3. Recent Upper Respiratory Infection
  4. Absent history of Corneal Trauma
  5. Severe Eye Pain
  6. Photophobia
  7. Eye Discharge
  8. Gritty Sensation in eye
  • Signs
  1. Unilateral inflammation of Conjunctiva and Cornea
  2. Dendritic Ulcers on Fluorescein staining of Cornea (consider rose bengal strips if available)
  3. Reduced Corneal sensitivity
  4. Preauricualar node (anterior to tragus)
  • Complications
  1. Corneal Ulcer and scarring with obscured Vision
  • Management
  1. Urgent Ophthalmology referral
  2. Consider Hospital admission
  3. AVOID Topical Steroids
  4. Topical Antivirals
    1. Ganciclovir 0.15% ophthalmic gel (Zirgan)
    2. Trifluridine 1% drops (Viroptic)
  5. Systemic Acyclovir or other Antiviral Agents
    1. Do not use topical Acyclovir due to to Corneal toxicity
  • References
  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Pflipsen (2016) Am Fam Physician 93(12): 991-8 [PubMed]