2. OBJECTIVES
DESCRIBE THE INTRODUCTION AND PATHOPHYSIOLOGY OF
HERPES SIMPLEX VIRUS AND HERPES ZOSTER VIRUS
DESCRIBE THE CLINICAL MANIFESTATIONS OF VIRAL
KERATITIS
IDENTIFY THE MOST COMMON DIFFERENCES OF HERPES
SIMPLEX VIRUS AND HERPES ZOSTER VIRUS
3. Viral keratitis is the most common form of keratitis in
developed countries
4. Herpes Simplex Virus
MODE OF INFECTION
Lips, nose and cornea: HSV-1 (above abdomen)
(Close contact with patient suffering from
herpes labialis)
Genitals: HSV-2 (below abdomen)
(to eye of neonate through infected genitalia of
Mother)
5. ✴ Acute follicular conjunctivitis
✴ Keratoconjunctivitis (lymphadenopathy)
✴ Periocular & eyelid skin lesions
• HSV keratitis in a neonate
is invariably associated
with conjunctivitis.
• Features; Diffuse
microdendritis, serpiginous
epithelial defects or a punctate
keratitis.
10. NEUROTROPHIC EPITHELIAL
KERATITIS
• Arises from impaired corneal innervation combination with
decrease tear
secretion.
• Failure of re-epithelization resulting from corneal anaesthesia.
Chronic post-herpetic corneal inflammation
Defect is oval in shape,Smooth borders,STROMA
beneath it is grey
and opaque
COMPLICATIONS
STROMAL SCARRING, NVZ, NECROSIS, PERFORATION ,SEC.
BACTERIAL INFECTION
11. HSV STROMAL KERATITIS
IMMUNE MEDIATED STROMAL
KERATITIS
Called interstitial keratitis
Type 3 immune reaction by viral
antigen
FEATURES
Stromal infilteration (punctate
opacities)
Stromal NVZ
WESSELY IMMUNE RING
NECROTIZING STROMAL
KERATITIS
Direct invasion of stroma by
HSV→active viral
infection→intense stromal
inflammation
Epithelial defect, corneal necrosis
and melting
COMPLICATIONS
Corneal scarring, Corneal thinning
and perforation, Uveitis
IMMUNE MEDIATED STROMAL
KERATITIS
NECROTIZING STROMAL
KERATITIS
12. HSV ENDOTHELITIS
DISCIFORM DIFFUSE LINEAR
Central disc
shaped stromal
edema
Overlying
epithelium edema
Few
granulomatous
KPs
Stromal
edema
involving
entire cornea
Scattered KP
over entire
endothelium
Line of KPs on
endothelium
Progress
centrally from
limbus
Edema
between line
of KP and
limbus
Delayed Hypersensitivity reaction
(typeIV) to Herpes
antigen
13. HERPES ZOSTER OPHTHALMICUS
known as shingles/Zoster, is a viral
disease
characterized by a painful skin rash
in one or more dermatome
distributions of the fifth cranial
nerve, shared by the eye and orbit.
Anatomy of CN V
15. Risk factors= age > 60 years, immunocompromised,
pregnant women, neonates, aids
CLINICAL MANIFESTATIONS
PRODROML PHASE
(fever,malaise,headache,eyepa
in)
Erythmetaous skin lesions
Macules->papules->vesicles-
>pustules->scabes
If the vesicles are present on
the side and tip of the nose,
(Hutchinson's sign), the
external division of the
nasociliary branch is affected
: probability of involvement of
eye 76%
OCULAR
70% HZO patients have
ocular involvement
-
conjunctivitis/episcleritis:
53%
- epithelial keratitis: 33%
- uveitis: 32%
- stromal keratitis: 14.5%
- endothelitis: 6.5
