Red Eye - Cornea
HSV Keratitis
Corneal ulcer
Aetiology
Source
Toronto Notes 2012
- Usually HSV type 1 (90% of population are carriers)
- May be triggered by stress, fever, sun exposure, immunosuppression
- Pain, tearing, foreign body sensation, red eye, may have decreased vision, eyelid oedema
- Corneal hypoesthesia
- Dendritic (thin and branching) lesion in epithelium that stains with fluorescein
- Corneal scarring (can lead to loss of vision)
- Chronic interstitial keratitis due to penetration of virus into stroma
- 2° iritis, 2° glaucoma
- Topical antiviral such as trifluridine, consider systemic antiviral such as acyclovir
- Dendritic debridement
- NO STEROIDS initially- may exacerbate condition
- Ophthalmologist must exercise caution if adding topical steroids for chronic keratitis or iritis
Corneal ulcer
Aetiology
- Local necrosis of corneal tissue due to infection (Figure 14)
- Infection is usually bacterial, rarely viral, fungal or protozoan (Acanthamoeba)
- 2° to corneal exposure, abrasion, foreign body, contact lens use (50% of ulcers)
- Also associated with conjunctivitis, blepharitis, keratitis, vitamin A deficiency
- Pain, photophobia, tearing, foreign body sensation, decreased VA (if central ulcer)
- Corneal opacity that necroses and forms an excavated ulcer with infiltrative base
- Overlying corneal epithelial defect that stains with fluorescein
- May develop corneal edema, conjunctival injection, anterior chamber cells/flare, hypopyon (inflammatory cells in ant chamber), corneal hypoesthesia (in viral keratitis)
- Bacterial ulcers may have purulent discharge, viral ulcers may have watery discharge
- Decreased vision, corneal perforation, iritis, endophthalmitis
- Urgent referral to ophthalmology
- Culture first
- Topical antibiotics every hour
- Must treat vigorously to avoid complications
Source
Toronto Notes 2012