4d • General discussion
HSV Keratitis: Small Virus, Big Impact on Vision
By Dr Kashmira Rawjee
Today’s case is a 41 year old female presenting with reduced visual acuity of 0.5 in the right eye. A diagnosis of immune stromal keratitis was made and the patient was treated with oral acyclovir and topical cortisone. Visual acuity improved to 0.9 in 2 weeks on the above treatment.
Disciform keratitis is also known as immune stromal keratitis. The pathophysiology is an immune mediated reaction to Herpes Simplex Virus rather than viral replication and the findings therefore differ from classic dendritic keratitis.
Clinically it presents as central stromal oedema with an intact corneal epithelium. There is reduced corneal sensitivity and and only mild discomfort in comparison to disproportionate drop in visual acuity. Keratic precipitates are usually absent and the anterior chamber is quiet.
Although the most common presentation is as a disciform keratitis, other forms include linear, diffuse and sectoral.
Management consists of systemic antiviral agents in therapeutic doses for 10-14 days and judicious use of topical corticosteroid drops .
Intraocular pressure needs to be monitored and close follow up is required to taper the medication depending on the response to treatment.
Timely recognition is imperative and prevents mismanagement. Topical steroids can be vision saving but only when paired with appropriate antiviral cover to prevent reactivation.
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HSV Keratitis: Small Virus, Big Impact on Vision
