Core EM

Trifluridine 1% solution: 1 drop Q2hours for 7 days OR Ganciclovir 0.15% gel: five times per day. Oral antiviral agents (not FDA approved, but equal efficacy in studies) (Wilhelmus 2010).

 Herpetic Keratitis: A Review and What’s New

Most of the treatment that we talk about when we’re talking about simplex keratitis was learned by the herpetic eye disease study. This was a study that came out in the early ’90s. That was a multicenter study across the world. That came out with just tons and tons of literature. We don’t have time to go into the herpetic eye disease study, but I encourage you to read it. When HEDS came out, the only topical treatment that we had for simplex keratitis was trifluridine, Viroptic. It’s not that great of a drug anymore. One of the things I wanted to talk about was to encourage you guys to use some of the new drugs. If you have epithelial disease, you’re dosing your patient nine times a day with Viroptic. It’s pretty toxic to the epithelium.

A Case of Herpes Simplex Virus Keratitis in The Emergency Department

After the initial infection, the virus can remain latent in the ophthalmic division of the trigeminal ganglion for the lifetime of the host. HSV reactivation in the latently infected ganglia can lead to corneal scarring, thinning, stromal opacity, and neovascularization. The cumulative effect of numerous infections results in vision loss and eventually blindness if left untreated.

Approach to Corneal Disorders in the ED

Based on the slit lamp findings, you diagnose Tom with herpes simplex keratitis. You give him a prescription for Valacyclovir 1 g TID, arrange next day ophthalmology follow-up, and give him return instructions to come back if his pain worsens or vision deteriorates.

Approach to the Red Eye

HSV keratitis is caused by the herpes simplex virus and is an infection of the cornea. The virus remains in the trigeminal nerve when inactive and patients can have reactivations of the virus for the remainder of their life. Immunocompromised patients are at more risk for reactivation of disease. HSV is a serious infection and can lead to permanent vision loss if not treated promptly. Diagnosis is usually clinical and made on fluorescein exam.

Herpes Simplex Epithelial Keratitis and Proposed Treatments

There is much controversy surrounding whether an oral antiviral should be added to topical antiviral therapy in the management of HSV keratitis. According to the first Herpetic Eye Disease Study (HEDS 1), there is no apparent benefit in the addition of oral acyclovir to corticosteroids and trifluridine in the treatment of HSV stromal keratitis.

Herpetic Keratitis, Patience is a Virtue: HSK in Immunocompromised Patient

The Herpes virus is ubiquitous in our patient population. Often it is present without symptoms, however, it may present with pain, irritation, and decreased vision. In high-risk populations a longer course of treatment is often required.

HSV Keratitis

The most well-known herpetic infection and the most common is infectious epithelial keratitis, said Prof Seitz. It may take the form of dendritic keratitis with branching linear lesions that typically break through the basal membrane of the cornea, with terminal enlargements, and swollen epithelial margins with living virus. If the dendrites become confluent, it may evolve into geographic keratitis. It is also important to distinguish infectious epithelial keratitis from acanthamoeba keratitis, a rare opportunistic infection that presents with similar non-specific symptoms as bacterial and viral keratitis.

What is Herpes Keratitis?

While both Type I and Type II herpes can spread to the eye and cause infection, Type I is by far the most frequent cause of eye infections. Infection can be transferred to the eye by touching an active lesion and then your eye. It is rare to transfer Type II to the eye.