Herpetic keratitis: dendritic ulcers & disciform keratitis David Kinshuck |
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What is the cornea? |
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The cornea is the 'window' of your eye. It is the clear glass-like front. |
the cornea |
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the cornea, side view |
What is the herpes virus? |
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The herpes simplex virus is very common. Most people have a herpetic infection at some time of their lives. However, only in a few unlucky people does the virus affect the cornea. No one knows why some people develop corneal infections not others. It has nothing to do with sex ...that is a different type of herpes virus. |
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What are dendritic ulcers? |
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The virus causes a special type of corneal ulcer, called 'dendritic' (after the latin term that means 'many fingered'). A dendritic ulcer has many 'fingers', like the branch of a tree. It can be seen with the slit lamp microscope used to examine your eye. Fluorescent yellow drops are used to show the ulcer up more easily.
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a dendritic ulcer: as seen by your doctor
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![]() a dendritic ulcer: side view |
What do you feel? |
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As the cornea has many nerves it feels pain easily. Dendritic corneal ulcers are painful; your eye feels as though something is scratching it. Sunlight and bright lights feel painful also. As the ulcer is like 'paint on a window' your sight may be blurred.
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The treatment |
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The treatment is aciclovir cream (eye) 3% ointment 5 times a day for 7 days. Depending on your particular ulcer, a different treatment time, and occasionally different drugs, will be needed. With prompt treatment you get a 100% recovery. Sometimes you get a faint scar, although this is more likely without treatment. Use aciclovir ointment, not the skin cream. Bring it to clinic each visit, with all your other drops and list of tablets you use. It is very safe. Use about 2cm length of cream 5 times a day at the beginning, but later in the episode as your eye heals you need less (5-10mm), although you may still need it 5 times a day. |
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Recurrences: can you treat yourself? |
Dendritic ulcers may recur. It is certainly helpful to keep a tube of unopened ointment with you, especially on holiday. If you do develop another episode it is quite safe to start treatment. (Aciclovir is safe even if you are mistaken and there is no infection.) Use the aciclovir, following typical instructions as above. Most doctors advise you attend an Eye Casualty, such as that in Birmingham and Midland Eye Centre on the City Hospital site (Dudley Road), that day or the next. Treatment is not so urgent as to need to attend late in the evening or the middle of the night. Like any infection, stress, overwork, or lack of sleep can trigger a recurrence. Dendritic ulcers can be triggered by sunlight. Dark glasses may help prevent a recurrence, and they certainly help during an attack. If you develop frequent episodes, ask your doctor if long term aciclovir cream or tablets may be helpful as prevention. |
Recurrences can be prevented |
There is now conclusive evidence that attacks can be prevented with the use of aciclovir, see here (2003). Treatment may be needed for 2-3 years.
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'Stromal' or 'herpetic' keratitis |
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If
the infection is in the substance of the cornea the condition is called
'stromal keratitis' (also called 'disciform' or 'herpetic'). Stromal keratitis attacks may recur frequently. If they do, preventative treatment may work. Aciclovir tablets 400mg once or twice a day halves the number of episodes, but may be needed for a year or two. |
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For Professionals: steroid drops in herpetic keratitis etc |
Some
patients with delayed healing dendritic ulcers may need a different antiviral,
but resistance is unusual and this is not usually necessary.
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Leaflet download |
If
you
are a health professional and want to have a leafet to give to give to
patients, instead of this web page, see 200k
Adobe PDF
Alternatively, this is a Microsoft Publisher document click here, and you are welcome to download it and print copies. You are welcome to make changes for your patients (you can edit the leaflet in Microsoft Publisher). You will need M Publisher
2000 to open and print the document. M Publisher is bundled as part of
Microsoft Office. The only condition is that you let me know if there
are any errors. www.diabeticretinopathy.org.uk/leaflets/herpetickeratitis.pub |
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The address of this site ('org' changing to 'nhs') is changing from http://www.goodhope.org.uk/departments/eyedept/ to http://www.goodhope.nhs.uk/departments/eyedept/ |
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