Herpes simplex keratitis - Revision history

Elcatracho: /* Clinical Features */

2021-03-12T16:47:44Z

Clinical Features

← Older revision		Revision as of 16:47, 12 March 2021
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	*Normal pupil size and [[intraocular pressure]]		*Normal pupil size and [[intraocular pressure]]
	*Dendritic ulcers with fluorescein		*Dendritic ulcers with fluorescein
			**May also see "geographic ulcers" - amoeba-like ulceration with dendrites at the edges<ref>Go S. Eye Emergencies. In: Cydulka RK, Fitch MT, Joing SA, Wang VJ, Cline DM, Ma O. eds. Tintinalli's Emergency Medicine Manual, 8e. McGraw-Hill; Accessed March 12, 2021. https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=2158&sectionid=162273694</ref>
	*Severe cases may cause [[uveitis]], [[iritis]]		*Severe cases may cause [[uveitis]], [[iritis]]

Rossdonaldson1: Rossdonaldson1 moved page Herpes keratitis to Herpes simplex keratitis

2020-09-26T19:14:40Z

Rossdonaldson1 moved page Herpes keratitis to Herpes simplex keratitis

← Older revision	Revision as of 19:14, 26 September 2020
(No difference)

Rossdonaldson1: /* Background */

2020-09-26T19:13:52Z

Background

← Older revision		Revision as of 19:13, 26 September 2020
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	*Most common cause of corneal blindness in US		*Most common cause of corneal blindness in US
	*Avoid topical steroids to prevent necrotizing stromal keratitis		*Avoid topical steroids to prevent necrotizing stromal keratitis

			{{Conjunctivitis DDX}}

	==Clinical Features==		==Clinical Features==

NadavNahumi: /* Management */

2020-03-19T02:27:34Z

Management

← Older revision		Revision as of 02:27, 19 March 2020
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	==Management==		==Management==
	*Topical options		*Topical options
	**[[Ganciclovir]] ~~optho~~ gel 0.15% 5x daily		**Acyclovir 3% ophthalmic ointment 5x daily
	**[[Cycloplegic]] for symptoms - [[Cyclopentolate]] 1% x1 drop ~~TID~~, lasts for a day		***Continued for three days after clearing of corneal lesions
	*Oral [[acyclovir]] or [[valacyclovir]] may be used alone or in combo with topical		**If unavailable, [[Ganciclovir]] ophthalmic gel 0.15% 5x daily
			**[[Cycloplegic]] for symptoms - [[Cyclopentolate]] 1% x1 drop 3x daily, lasts for a day
			*Oral [[acyclovir]] (400mg 5x daily) or [[valacyclovir]] (500mg 3x daily) may be used alone or in combo with topical
			**Treatment can be stopped one week after healing of the lesions
	*Avoid topical steroids unless in consult with ophtho (steroids can be started when infectious treatment adequately underway)		*Avoid topical steroids unless in consult with ophtho (steroids can be started when infectious treatment adequately underway)

NadavNahumi: /* Evaluation */

2020-03-19T02:20:50Z

Evaluation

← Older revision		Revision as of 02:20, 19 March 2020
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	==Evaluation==		==Evaluation==
	''Clinical diagnosis with staining and slit lamp exam''		Clinical diagnosis with staining and slit lamp exam

	==Management==		==Management==

ClaireLewis at 16:56, 5 October 2019

2019-10-05T16:56:48Z

← Older revision		Revision as of 16:56, 5 October 2019
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	==Clinical Features==		==Clinical Features==
	[[File:Herpes simplex geographic corneal ulcer.jpeg\|thumbnail\|Herpes keratitis]]		[[File:Herpes simplex geographic corneal ulcer.jpeg\|thumbnail\|Herpes keratitis]]
	*Blurred vision		[[File:HSVconjuctivitis.png\|thumbnail]]
			*[[Blurred vision]]
	*[[Eye pain]], photophobia		*[[Eye pain]], photophobia
			**More pain than with typical conjunctivitis
	*Tearing		*Tearing
	*Perilimbic injection		*Perilimbic injection
	*Normal pupil size and intraocular pressure		*Normal pupil size and [[intraocular pressure]]
	*Dendritic ulcers with fluorescein		*Dendritic ulcers with fluorescein
			*Severe cases may cause [[uveitis]], [[iritis]]

	==~~Differential Diagnosis~~==		===[[Slit lamp]]/Fluorescein===
	*[[~~Iritis]]~~
	*[[Conjunctivitis]]
	*[[Glaucoma]]
	*[[UV keratitis]]
	*[[Herpes zoster]]
	*Contact lens complication
	*Fungal keratitis
	*[[Bacterial keratitis]]
	*Interstitial keratitis
	~~{{HSV-1 DDX}}~~

	==~~Evaluation~~==
	~~''Clinical diagnosis with staining and slit lamp exam''~~
	*Epithelial disease		*Epithelial disease
	**Infectious epithelial keratitis		**Infectious epithelial keratitis
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	***Irregular corneal surface from immune response		***Irregular corneal surface from immune response
	***Decreased corneal sensitivity due to scarring, necrosis		***Decreased corneal sensitivity due to scarring, necrosis

	*Stromal keratitis - develops secondarily to in 25% of patients with epithelial disease		*Stromal keratitis - develops secondarily to in 25% of patients with epithelial disease
	**Necrotizing stromal keratitis - leads to thinning and perforation		**Necrotizing stromal keratitis - leads to thinning and perforation
	**Immune stromal keratitis - recurrent ocular HSV		**Immune stromal keratitis - recurrent ocular HSV

	*Endotheliitis (disease extending from epithelium to stroma to endothelium)		*Endotheliitis (disease extending from epithelium to stroma to endothelium)
	**Keratic precipitates		**Keratic precipitates
	**Accompanying iritis		**Accompanying iritis

			==Differential Diagnosis==
			*[[Iritis]]
			*[[Conjunctivitis]]
			*[[Glaucoma]]
			*[[UV keratitis]]
			*[[Herpes zoster]]
			*[[Contact lens]] complication
			*Fungal keratitis
			*[[Bacterial keratitis]]
			*Interstitial keratitis
			{{HSV-1 DDX}}

			==Evaluation==
			''Clinical diagnosis with staining and slit lamp exam''

	==Management==		==Management==
	*Topical options		*Topical options
	**[[Ganciclovir]] optho gel 0.15% 5x daily		**[[Ganciclovir]] optho gel 0.15% 5x daily
	**Cycloplegic for symptoms - [[Cyclopentolate]] 1% x1 drop TID, lasts for a day		**[[Cycloplegic]] for symptoms - [[Cyclopentolate]] 1% x1 drop TID, lasts for a day
	*Oral [[acyclovir]] or [[valacyclovir]] may be used alone or in combo with topical		*Oral [[acyclovir]] or [[valacyclovir]] may be used alone or in combo with topical
	*Avoid topical steroids unless in consult with ophtho (steroids can be started when infectious treatment adequately underway)		*Avoid topical steroids unless in consult with ophtho (steroids can be started when infectious treatment adequately underway)
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	[[Category:Ophthalmology]]		[[Category:Ophthalmology]]
			[[Category:ID]]

ClaireLewis: /* Management */

2017-04-03T15:31:15Z

Management

← Older revision		Revision as of 15:31, 3 April 2017
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	*Topical options		*Topical options
	**[[Ganciclovir]] optho gel 0.15% 5x daily		**[[Ganciclovir]] optho gel 0.15% 5x daily
	**Cycloplegic for symptoms - Cyclopentolate 1% x1 drop TID, lasts for a day		**Cycloplegic for symptoms - [[Cyclopentolate]] 1% x1 drop TID, lasts for a day
	*Oral acyclovir or valacyclovir may be used alone or in combo with topical		*Oral [[acyclovir]] or [[valacyclovir]] may be used alone or in combo with topical
	*Avoid topical steroids unless in consult with ophtho (steroids can be started when infectious treatment adequately underway)		*Avoid topical steroids unless in consult with ophtho (steroids can be started when infectious treatment adequately underway)

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T11:39:07Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 11:39, 23 July 2016
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	{{HSV-1 DDX}}		{{HSV-1 DDX}}

	==~~Diagnosis~~==		==Evaluation==
	''Clinical diagnosis with staining and slit lamp exam''		''Clinical diagnosis with staining and slit lamp exam''
	*Epithelial disease		*Epithelial disease

ClaireLewis: /* Disposition */

2016-07-14T00:19:07Z

Disposition

← Older revision		Revision as of 00:19, 14 July 2016
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	==Disposition==		==Disposition==
	*Usually self-limiting with most experiencing resolution within 3 wks		*Usually self-limiting with most experiencing resolution within 3 wks
	*~~Outpt~~ consult to ophtho for refractory cases, ulcers needing debridement, and multiple recurrences		*Outpatient consult to ophtho for refractory cases, ulcers needing debridement, and multiple recurrences

	==See Also==		==See Also==

ClaireLewis: /* Management */

2016-07-14T00:18:54Z

Management

← Older revision		Revision as of 00:18, 14 July 2016
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	==Management==		==Management==
	*Topical options		*Topical options
	**Ganciclovir optho gel 0.15% 5x daily		**[[Ganciclovir]] optho gel 0.15% 5x daily
	**Cycloplegic for symptoms - Cyclopentolate 1% x1 drop TID, lasts for a day		**Cycloplegic for symptoms - Cyclopentolate 1% x1 drop TID, lasts for a day
	*Oral acyclovir or valacyclovir may be used alone or in combo with topical		*Oral acyclovir or valacyclovir may be used alone or in combo with topical