Viral Keratitis

Clinical Description

Corneal inflammation caused by viral infection

Signs and Symptoms

• Painful red eyes, Photophobia, blurred vision, circumlimbal injection and corneal opacities ± oedema ± anterior uveitis,
• Corneal staining in a dendritic pattern, reduced corneal sensitivity

Investigations

Corneal scrapings (microscopy, culture, sensitivity))

Treatment

• Treatment of epithelial keratitis
• Topical Acyclovir 3% ointment five times daily.
• Acyclovir 200–400 mg PO five times a day for 5–10 days indicated in immunodeficient patients, children, and patients with marked ocular surface disease.
• Debridement may be used for dendritic but not geographic ulcers.
• The majority of dendritic ulcers will eventually heal spontaneously without treatment.
• Treatment of Disciform Keratitis
• Initially with topical steroids (Prednisolone 0.5% eye drops) with Acyclovir 5% eye ointment both EVERY 6HRS for 4 weeks, then tapering of both can be done
• A weak steroid such Fluorometholone 0.1% on alternate days maybe used subsequently for several months
• Treatment of Stromal Necrotic Keratitis
• Lowest effective topical steroid therapy to control inflammation
• Topical Acyclovir 5% eye ointment five times a day
• Oral Acyclovir (400mg every 12hrs for a year) to reduce the rate of recurrent epithelial and stromal keratitis. The benefit is greatest in patients with frequent debilitating bilateral disease or if involving an only eye