Health, Diseases and Conditions
Herpetic keratitis: a description, forms, causes, symptoms and treatment
Inflammatory processes in the cornea can be caused by endogenous and exogenous keratitis. In the first case, internal processes lead to their development . Exogenous keratitis is provoked by external factors. Identify the reasons that led to the development of the disease, and establish an accurate diagnosis should an ophthalmologist.
Description of the problem
But the cause of herpes keratitis can also be:
- Herpes simplex virus type 2;
- herpes zoster (it causes shingles and chickenpox);
- Epstein-Barr virus;
Cytomegalovirus.
But most of the time the eyes are affected by HSV-1.
Herpetic keratitis is characterized by the fact that the membrane of the eye becomes cloudy. As a result of such a lesion, a person's eyesight deteriorates considerably, he may even go blind.
Symptoms of the disease
- watery eyes;
- Blepharospasm (a condition in which the eyelids involuntarily close spasmodically);
- photophobia.
But this is not yet a complete list of signs by which you can determine herpetic keratitis. Symptoms of the disease can be as follows:
Reddening of the eye;
- feeling of getting foreign body;
- Burning sensation;
- pain in the eye.
With the primary infection, there may be vesicles on the eyelid and conjunctiva. It heals without scarring. The cornea during primary lesion remains mostly untouched.
Reactivation of the virus causes periodic herpetic keratitis. The case history, forms of the disease are important for further diagnosis and treatment tactics. In latent form, the virus remains in the sensory ganglion. When reactivated, it is transported to the nerve endings, after which the eyeball becomes infected.
Forms of the disease
Specialists distinguish a tree-like and geographic type of disease. The diagnosis is established depending on how widespread the inflammatory reaction is. It is also important how badly the corneal tissue is destroyed.
Doctors diagnose "dendritic herpetic keratitis" in cases where ulcers on the cornea are like branches of trees. The situation is slightly worse if the doctor speaks of a geographical defeat. This means that the cornea is damaged more seriously. The areas of the destroyed epithelium are significant, and their outlines resemble a schematic representation of the continents on the maps.
Stromal keratitis is also called discoid. This disease affects not the outer layer of the cornea, but its internal surface - the stroma. The most dangerous species is stromal necrotic keratitis. In this type of disease, inflammation develops rapidly. It can cause destruction of the corneal tissue. Ultimately, this can lead to blindness.
The first two forms of herpetic keratitis (tree and geographic) with adequate treatment result in complete recovery.
Diagnostics
The doctor evaluates the patient's condition, looks at the manifestations of the disease. He also measures the intraocular pressure. To determine the extent of damage, it is necessary to drip fluorescein into the eyes. This is a special reagent, which is visible under ultraviolet light. With its help, you can evaluate how herpetic keratitis damaged the surface of the cornea.
Also, diagnostics can reveal which layers the virus has struck. Depending on this, the tactics of treatment will be determined.
Laboratory research
To conduct it, you can take smears from the cornea. But such research is low-sensitivity. DNA testing is more informative. However, this is quite an expensive examination, so it is used extremely rarely. Serological tests are informative at primary lesion: they show the growth of antibodies. But when the virus is reactivated, they become useless.
Causes of the disease
Herpetic keratitis of the eye is an infectious disease. In the primary lesion of the herpes simplex virus, in most cases no symptoms appear. Occasionally, characteristic bubbles may develop around the lips.
Once in the body, the virus remains forever in the cells of the trigeminal nerve. It is in a latent state. But from time to time, reactivation is possible. In this case, the pathogen begins to multiply actively. Viruses can travel to the tissues of the face and eyes.
Herpetic keratitis, as a rule, appears just after the reactivation of this virus. Once on the cornea of the eye, the virus continues to multiply.
But the destruction of tissues begins because of the reaction of the immune system. After all, it is responsible for the development of an inflammatory reaction. Immune cells can recognize viruses and destroy tissues that are infected. Sometimes the harm from the reaction of immunity is much stronger than from the action of the virus itself.
What leads to the reactivation of the virus?
For a long time physicians believed that the virus is activated against the background of stress. But a survey of a group of people disproved this assumption. Therefore, doctors can not say exactly what causes this type of keratitis.
But it is established that those people who suffered various operations before their eyes are more susceptible to this disease. It can be laser correction of vision, removal of a cataract, treatment of a glaucoma, transplantation of a cornea.
Tactics of treatment
The necessary therapy can be prescribed only after examining the ophthalmologist. He must confirm the diagnosis of "herpetic keratitis of the eye". Treatment is also selected by a specialist.
If herpes affected only the eyelids, then it will be enough to only use tablets "Acyclovir" or "Valaciclovir". They need to be drunk for 5 days. To treat epithelial keratitis, you will need to purchase an eye gel that contains 0.15% ganciclovir or drops with 1% trifluridine. Also, an ointment "Acyclovir" can be prescribed. It should be laid for the lower eyelid at least 5 times a day.
Treatment continues until complete healing. In some cases it is enough to take only tablets "Acyclovir". If such treatment is ineffective, then drops with interferon are used.
Stromal keratitis is harder to treat. In the first two days, tablets "Acyclovir" (2 g per day) or "Valaciclovir" (1 g per day) are prescribed. In such a dosage, they should be drunk for up to 2 weeks. If in the first two days of the course the disease does not progress, then in the future it is recommended to use drops with dexamethasone 0.1%. Initially, they drip up to 8 times a day, but gradually the frequency of use is reduced every 3-6 days per 1 drop. Such treatment should last several months.
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