Herpetic Keratitis,
commonly known as
Eye Herpes
is an inflammation
of the cornea, the
clear dome that covers
the front part of
the eye. Herpetic
Keratitis is caused
by the Herpes Simplex
viruses.
Overview,
Causes, & Risk Factors
Nearly everyone is exposed
to the virus during
childhood. Herpes
simplex is transmitted
through bodily fluids,
and children are often
infected by the saliva
of an adult. The
initial infection is
usually mild, causing
only a sore throat or
mouth. After exposure,
herpes simplex usually
lies dormant in the
nerve that supplies
the eye and skin. |
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When the eye is involved,
herpes simplex typically
affects the eyelids,
conjunctiva, and cornea.
Keratitis (swelling
caused by the infection),
a problem affecting
the cornea, is often
the first ocular sign
of the disease.
In some cases, the
infection extends
to the middle layers
of the cornea, increasing
the possibility of
permanent scarring.
Some patients develop
uveitis, an
inflammatory
condition that affects
other eye tissues.
Signs
and Symptoms
Pain, redness of
the eye, excess tears,
light sensitivity,
irritation, itchiness,
and decreased vision
are usually the symptoms
of eye herpes.
Herpes simplex virus
(HSV) infections involving
the lid may present
in one of two forms.
The classic appearance
involves an accumulation
of small vesicles
or pustules along
the lid margin and/or
periocular skin. These
lesions typically
have an inflamed,
erythematous base.
Within the first week
of infection, the
vesicles may ulcerate
or harden into crusts.
A second “erosive-ulcerative”
form of HSV blepharitis
has also been described.
This presentation
is characterized by
erosions of the lid
at the Gray line or
ulcers along the lid
margin, or a combination
of both. The lid typically
displays generalized
swelling and redness
associated with these
lesions.
HSV blepharitis
is encountered primarily
in children, although
adults may also manifest
this disorder. Presenting
symptoms include pain
and tenderness upon
palpation, as well
as increased lachrymation
in severe cases. If
the conjunctiva is
involved, tarsal follicles
may be observed along
with bulbar injection
and chemosis. Swollen
pre-auricular nodes
(pre-auricular lymphadenopathy)
on the involved side
is common.
Primary ocular infections
occur most often in
children between the
ages of 6 months and
5 years, and almost
invariably present as
blepharitis or blepharoconjunctivitis.
In recurrent attacks,
the virus usually reappears
as a dendritic keratitis.
Several reports of recurrent
HSV blepharitis have
been reported in the
literature, however.
Detection
and Diagnosis
Herpes simplex is
diagnosed by slit
lamp examination.
Tinted eye drops that
highlight the affected
areas of the cornea
may be instilled to
help the doctor evaluate
the extent of the
infection.
Treatment
Treatment of herpes
simplex keratitis
depends on the severity.
An initial outbreak
is typically treated
with topical and sometimes
oral anti-viral medication.
The doctor may gently
scrape the affected
area of the cornea
to remove the diseased
cells. Patients
who experience permanent
corneal scarring as
a result of severe
and recurrent infections
may require a corneal
transplant to restore
their vision.
There is no specific
treatment for HSV
blepharitis, and most
often the course of
the disease is self-limiting.
The use of warm saline
compresses with a
topical drying agent
(e.g. 70% alcohol)
is usually sufficient
to palliate the patient.
If the lesions are
extensive, concomitant
use of a topical antibiotic
ointment is prudent
to prevent a secondary
opportunistic bacterial
infection. The use
of topical or oral
antiviral agents has
not been proven to
enhance the recovery
of patients with HSV
blepharitis, although
it is advocated by
some practitioners
for more severe cases.
The use of topical
steroids on HSV lid
lesions may be unwise,
particularly if there
is other ocular involvement.
Although corticosteroids
may be used without
fear in cases of herpes
zoster (HZO) blepharitis,
their use in cases
of HSV infection may
predispose the patient
to the eruption of
a dendritic keratitis.
Additional Clinical
Information
Always include HZO
in the differential
diagnosis of HSV blepharitis.
Keep in mind, however,
that HZO typically
affects elderly patients
over the age of 70.
Younger patients who
present with HZO are
often immunocompromised
secondary to disorders
such as AIDS or lymphoma.
HSV blepharitis is
usually encountered
in children, but can
occur at any age.
Although herpes simplex
is known as a sexually
transmitted disease,
the vast majority
of ocular herpes infections
are not contracted
via sexual contact.
This is very important
to recognize when
considering pediatric
cases of HSV blepharitis. |
