CORNEA

Part 2
Herpes Simplex Keratitis

Introduction:
• It is caused by the herpes simplex virus.
• Almost 60% of corneal ulcers in developed and underdeveloped
countries are caused by this Virus.
• HSV 1 and HSV 2
Primary Infection
• Usually in childhood
• Spread through droplet infection, direct contact
• Subclinical presentation
Secondary Infection
• Subclinical reactivation
• Clinical reactivation
• Hundreds of reactivation can occur during a lifetime.
• Ocular recurrence rate
• Risk factor for severe disease
 • Symptoms are mild to moderate discomfort.
Epithelial • Redness, photophobia, blurred vision.

Keratitis • Follicular conjunctivitis and raised IOP

Disciform
Keratitis
• Central zone of stromal
edema.
• Folds in Descement
membrane.
• Wessely ring.
Necrotizing
stromal keratitis

• Stromal Melting and

necrosis often with
profound interstitial
opacification.
• Ant. Uveitis
• Progression to
scarring,Neovasculariza
tion,Lipid deposition
Neurotropic
Keratitis
• Impaired Corneal
sensation
• Decreased tear
production
• Anti-virals
HZO
• 1 in 3 will develop the condition during their lifetime
• HZO is the term used for shingles involving the dermatome-
supplied ophthalmic division of the Vth nerve.
• VZV causes both chickenpox(varicella), Shingles ( Herpes
zoster).
Mechanism of
ocular
involvment
• Direct invasion
• Secondary inflammation
and occlusive vasculitis
• Risk of ocular
involvement :
• Hutchinson sign
• Age
• AIDS
Acute
Shingles
• General Features:
• Prodromal Phase
lasts 3-5 days
• Tiredness, fever,
malaise, headache
• Skin Lesion:
Acute eye
disease
• Epithelial keratitis
• Conjunctivitis
• Episcleritis
• Scleritis
• Nummular Keratitis
• Stromal Keratitis
• Ant. Uveitis
Chronic Eye
Disease
• Neurotropic Keratitis
• Mucous Plaque Keratitis
• Lipid filled granulomata
• Eyelid scarring