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Herpetic keratitis
Last reviewed: 22.11.2021
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The frequency of the development of herpetic keratitis is steadily increasing.
Herpes is the cause of keratitis in 50% of adult patients and 70-80% in children. The spread of herpes in recent years is associated with the widespread use of steroid drugs, as well as an increase in the number of epidemics of influenza that provoke outbreaks of viral eye damage.
[What causes herpetic keratitis?
Herpes simplex virus is a DNA-containing virus that is pathogenic only to humans. The infection is widespread: almost in 90% of the population antibodies to the herpes simplex virus type I (HSV-1) are detected, however in most patients there are no or weak clinical signs of the disease. When an infection of the herpes simplex virus type I, mainly affects the upper body (face, including the lips, eyes). With the herpes simplex virus type II (HSV-2), which is a typical cause of acquired venereal disease, the lower body (genital herpes) is usually affected. Infection of the eye with HSV-2 virus can occur due to contact with the infected discharge genital tract during sexual contact or in childbirth.
- Primary infection with herpes simplex virus
Primary infection occurs in early childhood by airborne droplets, less often - with direct contact. During the first 6 months of life, the child is not susceptible to infection due to high titre in the blood of the maternal antibody. In primary infection, the clinical picture of the disease may be absent or manifest as a subfebrile condition, malaise and symptoms of upper respiratory tract infection. People with immunodeficiency can generalize the process and the emergence of life-threatening conditions.
- Recurrent herpesvirus infection
After primary infection, the virus along the axons of the sensitive fibers enters the ganglion (triple for HSV-1 and spinal for HSV-2), where it remains latent.
Under certain conditions, the virus reactivates, replicates and advances along the same axons in the opposite direction to the target tissue, which causes a relapse of the disease.
Without preventive treatment, repeated attacks of herpetic keratitis occur throughout the year in approximately 33% of individuals and within 2 years - in 66%.
Primary herpetic keratitis is keratitis, which develops when the body first meets the virus, when there are no specific antibodies in the blood. In the first half of the year the child is protected from infection by antibodies received from the mother, so infection occurs between 6 months and 5 years.
Primary herpetic keratitis begins acutely, flows heavily and for a long time, often against the background of influenza or other colds. Parotid lymph glands are enlarged; develops conjunctivitis, and then in the cornea appear whitish foci of infiltration or vesicles prone to ulceration. Corneal syndrome (photophobia, lacrimation, blepharospasm) is pronounced, an abundant neovascularization of the cornea develops, the iris and ciliary body can be involved in the pathological process. The inflammatory process ends with the formation of a gross corneal thorn. Primary herpes is characterized by recurrent inflammation along the edge of the formed corneal scar.
Postprimary herpetic keratitis is an inflammation of the cornea in a previously infected person who has a weak antigen titer, when the equilibrium between the viruses and the level of antibodies that are living in the body is disturbed.
Cooling, stress, ultraviolet irradiation, inflammatory processes lead to a decrease in the body's resistance. Septic foci can be found in other organs. After the primary herpetic keratitis has a subacute current, in the pathogenetic plan is a manifestation of a chronic infectious disease. Usually herpetic keratitis is not accompanied by conjunctivitis. With a decrease in the sensitivity of the cornea, photophobia and lacrimation are poorly expressed, neovascularization is insignificant. There is a tendency to relapse.
Symptoms of herpetic keratitis
By the nature of clinical manifestations, the surface and deep forms of herpetic keratitis are isolated.
The superficial forms of herpetic keratitis include corneal vesicle (vesicular) herpes, dendritic, landscape-shaped and marginal keratitis. In clinical practice, most often you have to deal with vesicular and dendritic keratitis.
Herpes vesicular herpes begins with the appearance of sharply expressed photophobia, lacrimation, blepharospasm, sensation of the foreign body in the eye, which are caused by the formation of small bubbles in the form of a raised epithelium on the surface of the cornea. Bubbles quickly burst, leaving behind an eroded surface. The healing of defects is slow, they are often infected with cocco flora, which significantly complicates the course of the disease. In place of erosions, infiltrates occur, they can acquire a purulent character. In the uncomplicated course after the closure of defects in the cornea, there are gentle scars in the form of a cloud, the influence of which on the function of the eye depends on the location of their localization.
Herpetic keratitis is manifested by the following signs:
- Vesicular rashes on the skin of the eyelids and periorbital area.
- Acute, unilateral, follicular conjunctivitis with an increase in premature lymph nodes,
- In some cases, secondary obstruction of lacrimal ducts may occur.
What do need to examine?
What tests are needed?
Treatment of herpetic keratitis
Treatment of herpetic keratitis is aimed at preventing the occurrence of keratitis. Use ointment acyclovir 5 times a day for 3 weeks. However, with the primary herpes, the eye keratitis occurs very rarely.
Antiviral treatment includes chemotherapy, nonspecific and specific immunotherapy. In the different stages of the disease, the appropriate combination of drugs is used. At the beginning of the disease, daily frequent kerecid instillation, deoxyribonuclease, lay ointments with tebrofen, florenalum, bonaflot, oxolin, zovirax 3-4 times a day. Every 5-10 days drugs are changed. Acyclovir is taken orally for 10 days. If the eye disease is combined with a herpetic inflammation of another localization, the duration of the course of treatment is increased to 1-2 months. In the case of severe complications, intravenous infusions of acyclovir are administered every 8 hours for 3-5 days. It is a highly active drug, but it has a narrow spectrum of action, so it is used against simple and herpes simplex viruses.