A 24 year old previously healthy male presents to the eye clinic with symptoms of red eye, tearing, pain and photophobia in his right eye. He says the symptoms developed over the course of the day yesterday, and were much worse upon wakening today. He has had no previous similar episodes, and complains of no vision loss, rashes, or recent upper respiratory infection. On examination visual acuity is 6/9 in the right eye and 6/6 in the left eye. Anterior segment exam reveals the following:
- To review the pathogenesis and classification of Herpes Keratitis
- To discuss treatment options for Herpes Keratitis
- To review the significance of the t-test
Quick Question: What is the most likely diagnosis?
Although herpes zoster can manifest as a dendritic appearing lesion, it is unlikely to stain positive with fluorescein. In addition, herpes zoster is most common in older individuals and is commonly associated with a painful rash.
Herpes simplex keratitisCorrect
Viral keratoconjunctivitis is a common cause of red eye and water discharge, but would not produce dendritic appearing ulcers. It is commonly associated with an upper respiratory tract infection and painful preauricular nodes.
The lesion does not have the appearance of a fungal ulcer.
Herpetic eye disease is a major worldwide cause of vision impairment. In developed countries the incidence of ocular herpes simplex virus (HSV) infection has been reported at 21-31 per 100 000 people per year.1,2 In the United States alone, over 300, 000 new cases of ocular HSV are reported annually.3 Although HSV can affect virtually all ocular and orbital tissue, this module will focus on corneal involvement, or herpes simplex keratitis (HSK).