Viral Keratitis

Question 1

Primary Infection of HSV

Answer 1

respiratory droplets

Question 2

HSV in first 6 months

Answer 2

uncommon because of maternal antibodies

Question 3

Recurrent Infections of HSV

Answer 3

reactivated by stressors

moves in peripheral nerves

Question 4

Signs of HSV Keratitis

Answer 4

swollen/ opaque epithelial cells and punctate keratopathy leading to dendritic ulcers
decreased K sensation
mild subepithelial haze
Maybe: AC rxn, follicular conj, vesicular lid lesions, IOP increase

Question 5

HSV Keratitis with steroids

Answer 5

geographic/ amoeboid appearance to ulcer

makes it worse

Question 6

Tx for HSV Keratitis

Answer 6

anti-viral gel or tablets 5x a day
Aciclovir cream 5x a day for skin vesicles
debridement

Question 7

Contraindications for HSV Keratitis

Answer 7

steroids
prostaglandin derivates (IOP)

Question 8

Prognosis for HSV Keratitis

Answer 8

ulcers normally heal in 2 weeks

subepithelial haze for weeks, increases with each recurrence

Question 9

Signs of HSV Stromal Keratitis

Answer 9

stromal infiltration without ulceration
AC rxn
stromal scarring, thinning, vascularization

Question 10

Tx for HSV Stromal Keratitis

Answer 10

topical steroids with antibiotic cover

Question 11

Disciform Endotheliitis

Answer 11

Recurrent HSV, part of immune rxn

Question 12

Symptoms of Disciform Endotheliitis

Answer 12

gradual blurring of vision with halos around light

Question 13

Signs of Disciform Endotheliitis

Answer 13

stromal edema in circular pattern in central zone
underlying KPs
immune Wessely ring of deep stromal haze

Question 14

Hx Related to Disciform Endotheliitis

Answer 14

decreased corneal sensitivity

Question 15

Tx for Disciform Endotheliitis

Answer 15

topical steroids with antibiotic cover

Question 16

Neurotrophic Keratopathy

Answer 16

associated with HSV
very low or no feeling in cornea from damaged nerves
decreases healing, leading to stromal scarring, corneal perforation, bacterial infection

Question 17

Contraindications of Neurotrophic Keratopathy

Answer 17

antiviral drops- makes non-healing defects worse

Question 18

Tx for Neurotrophic Keratopathy

Answer 18

lubricants

steroids for inflammation

Question 19

Iridocyclitis

Answer 19

associated with HSV

acute trabeculitis that can cause rise in IOP

Question 20

Tx for Iridocyclitis

Answer 20

steroids

Question 21

Prophylaxis of HSV Keratitis Outbreak

Answer 21

400mg oral aciclovir

Question 22

End result of severe HSV Keratitis

Answer 22

Keratoplasty

Question 23

Herpes Zoster Ophthalmicus

Answer 23

shingles involving ophthalmic division of trigeminal nerve

Question 24

Hutchinson Sign

Answer 24

trademark sign of HZO

if nose is involved, eye likely is too

Question 25

Tx for Shingles

Answer 25

oral antivirals- 800mg aciclovir 5x day for 5-7 days

Question 26

Signs of HZO

Answer 26

dendritic ulcers- smaller/ finer than HSV, self resolve
stromal keratitis- scar
anterior uveitis- elevates IOP
disciform keratitis
posterior uveitis- PRN/ ARN

Question 27

Long Term Effects of HZO

Answer 27

neurotrophic keratitis
scleritis
lid scarring
post herpetic neuralgia

Question 28

When to do corneal sensitivity testing

Answer 28

unilateral red eye