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Herpetic Eye Diseases
Terms in this set (13)
What are the 3 states of HSV cycle?
-Acute/primary infection: often asymptomatic, acquired from active lesion of individuals with HSV
-Latency: invade and travel along sensory nerves to trigeminal ganglion, remain 'dormant there'
Where is there no corneal pain in HSK?
Due to corneal hypoesthesia (reduced sensitivity) in HSV keratitis that is proportional to the number of recurrent episodes
(associated with slightly reduced number of corneal subepithelial nerves)
What is the diagnostic hallmark of HSV iridocyclitis and why?
Diagnostic hallmark is Inflammatory Ocular Hypertension Syndrome (IOHS)
-because there are nerves in the iris hence HSV pass down the nerve upon reactivation causing iridocyclitis and secondary trabeculitis => high IOP
What are general signs of viral infection?
What are the triggering factors for HSV reactivation?
-fever/cold/Upper respiratory tract URT infection
What ocular identities can HSV recurrence result in?
-HSV epithelial keratitis (dendritic/geographic ulcer)
-HSV stromal keratitis (necrotising or non-necrotising) (+/-secondary AC reaction)
-HSV endothelial keratitis (may present with stromal inflammation) (+secondary AC reaction)
-HSV neurotrophic keratitis
-HSV Iridocyclitis (associated trabeculitis)
What are the two types of HSV?
-HSV 1: orofacial
-HSV 2: genitourinary
Incidence of new and recurrence ophthalmic HSV?
20-32 cases/100,000 per year
Treatment of HSV stromal/endothelial keratitis?
-Referral to ophthalmologist if there is stromal involvement
-Prophylactic ORAL anti-viral: Oral Aciclovir 400mg, 5 times a day
-TOPICAL STEROID to control stromal inflammation
*ONLY initiate when there is no epithelial defect/or epithelium has healed
Prednisolone Acetate 1%, q3h For 7-14 days Taper slowly
-AC reaction: Atropine 1% tid
REVIEW: 24 hours then 48 hours, check IOP, ocular health, AC
Treatment of HSV epithelial keratitis?
-Topical antiviral: ACYCLOVIR 3% ointment
*5 times a day
*1cm ointment in lower fornix
*FOR 14 days or 3 days after epithelial defect has completely resolved
-Consider Atropine 1% tid for AC reaction, photophobia
-Consider Ocular lubricants for improved healing
-Counsel patient about 50% chance of recurrence
-Counsel about triggering factors for reactivation i.e: stress, UV, steroid use, immunosuppression, trauma
24hrs then 48 hrs thereafter until confident of diagnosis, ensure no stromal involvement; monitor IOP
Resolution should take 10-14 days, recheck diagnosis if condition persists after this time
How frequent are HSV recurrences?
1 year 9.6%, 2 years 22.9%, 5 years 40%, 10 years 67%
How many percent of patients with HZO will have corneal involvement?
Treatment of HZO keratitis?
-Referral to GP for oral anti-viral, Oral Aciclovir 800mg, 5 times a day, for 14 days
*Should be initiated within 72 hours of onset of lesions
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