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What is HSV?
- HSV1 & 2
- primary and secondary (remains in nerve ganglia
- lower cheek rash
Epithelial HSV sx?
- punctate epithelial vesicles
- fb, tearing, photo, RE, NO PAIN
- flourescein stain- peripheral dendrites WITH terminal buds, raised
- ddx: RCE, thygesons, bacterial keratitis
Stromal Disciform keratitis?
- inflammation of corneal stroma WO epi involvement
- minimal pain
- sx: blur, halo, discomfort, redness
- central stroma edema, keratic precips, folds in decemets, IOP raised, lower corn sens
- ddx: interstitial keratitis
Stromal HSV necrotising interstitial keratitis?
- ulceration with tissue/epi loss
- photophobia, blur, tearing, pain
- ddx: disciform: neo, stromal infilt, iron line
- diffuse corneal edema
- primary- chicken pox
- secondary- shingles (latent in nerve ganglion)
herpes zoster keratitis sx and tx?
- >60yo, uncommon
- Rash: doesn't cross midline (trigeminal nerve), Hutchinson's sign- vesicles on tip of nose
- Lesions: minimal stain, fine, dendretic, no terminal buds, central
- sx: photophobia, blur, tearing
- nummular keratitis
- develops 10 days after rash of HZO
- mutliple fine granular deposits beneath bowman's
TX of HZO?
antivirals, tear sups, pain management
- sx: watery discharge, follicular conjunctivitis, corneal opacities
- tx: self limiting, NOT ANTIVIRALS, tear supps
- young adults
- sx: irritation, burning, recurrent, multiple raised grey subep lesions, bi
- tx: NO ANTIVIRALS, lube, bandage CL