Dendritic Corneal Ulcer
Herpes Simplex Virus (Epitheliotropic)
- 1ry infection in early childhood
- Dormant in 5th Ganglion
- Recurrence with ↓ body resistance
Predisposing factors
- Fevers (Influenza, Common cold and Pneumonia)
- Menstruation
- Drugs (Immunosuppressive drugs or Steroids)
Clinical Picture
- 1ry Ocular infection
- Dermato-blepharitis
- Follicular Conjunctivitis
- Epithelia Keratitits
1ry Ocular Infection
Recurrent Ocular Infection (C/P of H. Keratitis)
-
Blepharoconjunctivitis (as 1ry infection)
-
Epithelial Keratitis
Symptoms : as those of corneal ulcer
Signs :
- A) SPK
- B) (Characters of Dendretic Herpetic Corneal Ulcer) - Dendritic appearance - Long course with tendency to Recurrence - Hypothesia - (decrease corneal sensation)
- C) Amoeboid Ulcer due to decreased immunity or local Steroids
Dendretic Herpetic Corneal Ulcer
Amoeboid Ulcer/ Geographic ulcer
it changes to this shape when used topical steroid
- Stromal Keratitis (Cell Mediated Immune Reaction)
- Herpetic Iridocyclitis
Treatment of Herpetic Epithelial Keratitis
-
Local Antiviral Drugs
- Acyclovir (Zovirax) 3% eye ointment 5 times/day
-
NB Corticosteroids are contraindicated
Treatment of Stromal H KeratitisZ
- Topical Corticosteroids
- Prophylactic Antiviral drugs
Treatment of Resistant Cases
- Debridement (to remove infected cells)
- Therapeutic L K
Herpes Zoster Ophthalmicus
- Varicella-Zoster Virus
- Neurotropic Virus
- Old age - ↓ Immunity
Clinical Picture: worseZ than herpes simplex - itis
- Lids : Dermatoblepharitis (pain and rash)
- Keratitis : (Hutchinson’s rule)
- Epithelial Keratitis (Punctate or dendritic)
- Interstitial Keratitis
- Scleritis
- Iris : 2ry iridocyclitis
- IOP : 2ry glaucoma
- Choroid : Focal choroiditis
Clinical Picture of H Z Ophthalmicus
- Retina: retinal vasculitis, detachment and necrosis
- Optic Nerve: Papillitis or Retrobulbar neuritis
- EOM: Paralytic Squint (3rd N. palsy)
Treatment:
- Acyclovir tab. 800mg 5 times/ day for 7 days
- Steroids + Antibiotic skin oint.
- Steroids + Antibiotic eye drops
- Analgesics