Patients with epithelial keratitis complain of foreign-body sensation, light sensitivity, redness and blurred vision.įocal or diffuse reduction in corneal sensation develops following recurrent epithelial keratitis. The underlying cornea has minimal inflammation. During eye exam the defect is examined after staining with fluorescein dye. This classic herpetic lesion consists of a linear branching corneal ulcer (dendritic ulcer). Signs and symptoms Primary infection įluorescein-stained cornea: geographic epithelial defects The global incidence (rate of new disease) of herpes keratitis is roughly 1.5 million, including 40,000 new cases of severe monocular visual impairment or blindness each year. Therefore, HSV infections are a large and worldwide public health problem. Keratitis caused by HSV is the most common cause of cornea-derived blindness in developed nations. It has been estimated that one third of the world population have recurrent infection. This is known as immune-mediated stromal keratitis. The response may result in the destruction of the corneal stroma, resulting in loss of vision due to opacification of the cornea. Antibody responses against the viral antigen expression in the stroma can trigger a massive immune response in the eye. Following persistent infection the concentration of viral DNA reaches a critical limit. Recurrence can be accompanied by chronic dry eye, low grade intermittent conjunctivitis, or chronic unexplained sinusitis. Sensation loss occurs in lesional areas, producing generalised corneal anaesthesia with repeated recurrences. The epithelial layer is sloughed off as the dendritic ulcer grows, and mild inflammation ( iritis) may occur in the underlying stroma of iris. Subsequent recurrences may be more severe, with infected epithelial cells showing larger dendritic ulceration, and lesions forming white plaques. Healing can be aided by the use of oral and topical antivirals. Most primary infections resolve spontaneously in a few weeks. Additional symptoms include dull pain deep inside the eye, mild to acute dryness, and sinusitis. Infection is unilateral, affecting one eye at a time. The effect of the lesions varies, from minor damage to the epithelium ( superficial punctate keratitis), to more serious consequences such as the formation of dendritic ulcers. Primary infection typically presents as swelling of the conjunctiva and eyelids ( blepharoconjunctivitis), accompanied by small white itchy lesions on the corneal surface. It begins with infection of epithelial cells on the surface of the eye and retrograde infection of nerves serving the cornea. Herpetic simplex keratitis is a form of keratitis caused by recurrent herpes simplex virus (HSV) infection in the cornea. Herpetic keratoconjunctivitis, herpesviral keratitisĭendritic corneal ulcer after fluorescein staining Medical condition Herpes simplex keratitis
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