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Viral Keratitis.pdf
- 1. VIRAL KERATITIS DR.NAZISH ANWAR ResidentOphthalmologist AFH, Lahore
- 2. OBJECTIVES DESCRIBE THEINTRODUCTION 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 keratitisis 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 follicularconjunctivitis ✴ 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.
- 6. PATHOPHYSIOLOGY (Trigger agentsfor reactivation – fever,UV exposure, stress,ocular trauma, immunocompromised)
- 9. INFCTIOUS EPITHELIAL KERATITIS Dendrites;fluorescein along the length of lesion Swollen epithelial borders; rose Bengal (devitalized cells)
- 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 IMMUNEMEDIATED 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 DIFFUSELINEAR 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
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- 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
- 16. HERPES ZOSTER KERATITIS EPITHELIAL KERATITIS STROMAL/ NUMMULAR KERATITIS DISCIFORM KERATITIS SUPERFICIAL PUNCTATE KERATITIS + PSEUDODENDRITI ES(2-3D) COIN SHAPED LESIONS IN SUPERFICIAL STROMA IMMUNE MEDIATED EDNDOTHELITIS DISC OF CORNEAL EDEMA MILD AC ACTIVITY FINE KPs Dendritic epithelial lesions with tapered ends
- 17. DIFFERENCE BETWEEN HSVAND HZO
- 18. DIFFERENCES BETWEEN HSVAND HZO TYPES= NEONATAL, PRIMARY , RECURRENCE (COMMON) APPEARS 1-2 WEEKS AFTER SKIN LESIONS SKIN LESIONS BUNCHED VESICLES ON LID, LIPS DENDRITES WITH TERMINAL BUDS ULCERATION COMMON RECURRENCE (UNCOMMON) MAY FOLLOW RASH MONTHS,YEARS LATER HUTCHISON SIGN PSEUDODENDRITES WITH TAPERED ENDS ULCERATION UNCOMMON HSV HZO
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