Hello and welcome to Case of the Day. I’m Dr Crowley and today we’re gonna discuss an interesting case where a young lady came in and she’s had a chronic history of Herpes Keratitis, that is, the cold sore type of fever blisters – the Herpes Simplex, got into her eye, just like you can get on your lip or your nose or inside your mouth, and this time it happens in her eye and she’s had it in a chronic manner. And she came back in today with another episode.
So, what is Herpes Keratitis from Herpes Simplex? Like I said it’s the same virus that causes the cold sores and what happens is, classically, you get a lesion on your cornea, that’s the clear part of your eye. And you get a lesion on the surface of your cornea and it looks like what we describe as a dendrite. So what does that look like? It looks like a river with all these tributaries or creeks coming in. So that’s what looks like a dendrite. And so that’s the classic sign of Herpes Keratitis as a dendrite. What we do with that is there’s antiviral medicines or eye drops we put patients on and that typically will take care of it. There’s some cases that can become difficult to treat but we’ll go into that later.
In just general terms, when someone comes in with Herpes Keratitis, about one third of people will get one time in their life in their eye and never get it again. About another third of people get it a second time and never get it again. But then you have about a third of patients who come in, who get it in a recurring chronic manner, which is what happened in her case. And so then that becomes more difficult to treat.
When it’s just front surface of cornea layers, then it really doesn’t scar the eye. You have episodes of pain, your eyes are red and irritated and once that heals and goes away, then you’re okay. It’s what happens after repeated episodes of infections, that gets deeper into the layers below the epithelium of the cornea and then it gets into the deeper layer and starts causing damage or scarring in the deeper layer of your cornea. And that becomes a problem because it happens in the middle layer of your cornea where the pupil is and will start blurring your vision or also cause loss of vision. And so we don’t want that to happen.
And so that Stromal layer, that deeper layer, we’re not sure what causes that, whether that is, there’s still some inactive virus particles that hang around the cornea that reactivate occasionally or whether there’s dead virus particles lying inside the cornea and your immune system reacts to that. Because the treatment for the deeper layers actually is to put someone on Cortisone, but you have to treat them with the antiviral at the same time or you’ll get an eruption of the surface part again. And so this person has had chronic, recurring infections and getting scarring of their cornea. Now some, in that case, when it’s recurring, a lot of times we put people on antivirals by mouth. That is, we get systemic antivirals they take everyday to try to keep these recurring infections from popping up.
A lot of people are not very happy with taking a systemic antiviral medicine for the rest of their life but that is certainly the common way of treating recurrent Herpes Keratitis. Another method that I have used with success, instead of taking it systemically, we keep them on the eyedrop maybe once a day of the antiviral and that keeps it under control. It keeps the recurrence from coming back. So if you have a Herpes infection in your eye, it needs to be treated immediately because you don’t want the deeper layers to get infected. And if you start getting recurrences, then you’re gonna have to go on a maintenance therapy of some sort. Classically, that’s gonna be antiviral systemically by mouth or an alternative is to put the antiviral drop in your eye but that’s a chronic thing you have to continually do.
So if you have any questions about Herpes Keratitis, or how Herpes infects the eye, you can try to contact us through the website and we’ll to answer any questions you have. If not, may God bless you with healthy eyes and great vision.