Clinical pattern of recurrent herpes simplex keratitis

Ramya, A V (2006) Clinical pattern of recurrent herpes simplex keratitis. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: The human herpes virus is an important source of ophthalmic morbidity worldwide. Herpes simplex virus however, continues to be an important cause of unilateral corneal blindness worldwide. It is a multifaceted disease capable of inducing the most baffling problems through both infectious and immune mechanisms. Despite considerable progress in understanding the virus at cellular and molecular levels the prospect of prevention still appears to be a long way off. AIM OF THE STUDY: The main objective of the study is To study the clinical pattern To assess the disease free intervals To assess the visual outcome Of recurrent herpes simplex keratitis in Government Rajaji Hospital – Madurai. MATERIALS AND METHODS: 46 patients were examined over a period of 1 year at the cornea services Government Rajaji Hospital – Madurai All patients with a clinically documented recurrent herpes simplex infection who were treated in our hospital were included in the study. They were analysed retrospectively using a standardized questionnaire which assessed the age, sex, clinical type of previous herpes simplex virus corneal disease, duration of disease free interval, trigger factors if any, laterality of the disease. A detailed slit lamp examination was done and the clinical type of herpes simplex keratitis was assessed. A diagnosis of epithelial keratitis was made when a branching linear dendritic ulcer or a geographic ulcer appearing as a broad area of epithelial defect with amoeboid borders was seen. Stromal keratitis was diagnosed when deeper layers of corneal stroma showed diffuse infiltration and odema of the stroma with or without necrosis, ulceration and vascularization. Necrotizing keratitis, interstitial keratitis, immune ring, limbal vasculitis, disciform keratitis are included in this. Keratouveitis was diagnosed when there was a severe corneal odema with or without vascularization and marked signs of anterior uveitis. Since it was difficult to differentiate clinically mild keratouveitis and endothelitis, both were clubbed together for the pattern of analysis of recurrences. Neurotropic ulcer was diagnosed when the patients presented with persistent epithelial defect with grey thickened elevated borders. The uniform treatment policy was adopted. Epithelial keratitis was treated with topical 3%acyclovir ointment 5 times a day for 2-3 weeks and topical ciprofloxin eye drops BD. Stromal keratitis was treated with topical prednisolone acetate in dosage according to the disease severity along with prophylactic 3% Acyclovir ointment BD and prophylactic ciprofloxin drops BD along with homatropine eye drops BD. Iridocyclitis was treated in the same way as stromal keratitis. Secondary glaucoma was treated with 0.5% timolol eye drops BD. When the patient has a combined pattern of epithelial & Stromal keratitis he was initially treated with topical 3% acyclovir ointment, homatropine eye drops BD and ciprofloxin eye drops BD until the epithelium starts healing and then was started on prenisolole acetate drops. These patients were followed up for one year using slit lamp examinations at 3 specified follow up visits during the one year and at additional times when the patient developed new ocular complaints. Of the 46 patients 12 patients lost follow up and were excluded from the study. The pattern of recurrence was studied for epithelial and stromal keratitis. The average disease free interval was calculated for epithelial and stromal keratitis taking into account only those eyes which recurred purely in the same pattern as its initial presentation. CONCLUSION: Herpes simplex eye infection is an important cause of corneal blindness. Recurrences of the disease are the major cause of ocular morbidity. It is being seen from the study that herpes simplex disease often recurs in the same clinical pattern as the first episode. It is also seen that stromal involvement though accounting for only about 30% of the initial presentation, it is the one which shows more number of recurrence at a shorter interval of time than that of epithelial involvement. Thus stromal keratitis accounts for the major cause of ocular morbidity due to herpes simplex keratitis. Hence an early recognition and prompt treatment is necessary and more light is to be shown on the ways of preventing recurrences through subsequent studies.

Item Type: Thesis (Masters)
Uncontrolled Keywords: recurrent herpes simplex keratitis; clinical pattern
Subjects: MEDICAL > Ophthalmology
Depositing User: Devi S
Date Deposited: 27 Sep 2017 10:41
Last Modified: 27 Sep 2017 10:41

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