Hello and welcome to Case of the Day. I’m Dr Croley and today we’re gonna discuss an interesting case that came in, of a gentleman who has a recurrent Herpes infection of his eye. And so we’ll go over first a little bit about what Herpes does in an eye typically and then we’ll discuss the more or the less common type of which recurrent and causes damage to the eye more extensively than just the one-time occurrence of the superficial infection.
So the cornea, the clear part of the eye that covers over your pupil and iris, that part of your eye is typically what is infected with the virus. And so it has a typical pattern and is most commonly caused by Herpes Type 1 and only on a rare occasion could you get a Type 2. And actually Herpes Zoster Shingles has a still different look typically in the eye can look sometimes a little bit similar. And so you have this dendritic pattern, superficial dendritic keratitis. And this Superficial Dendritic Keratitis looks like a river with all the tributaries and it has a typical appearance in most cases and that’s how we diagnose that it’s a Herpes infection of the eye. And typically we treat that with antivirals and in most cases, that takes care of it and that people do very well.
And so maybe one-third or forty percent of patients or so having one-time occurrence of a Herpes infection in the eye never happens again and it stays in the superficial layer. So your cornea has several layers, there’s an outer epithelium, then there’s a basement membrane called Bowman’s membrane, then there’s a Stroma, then there’s another layer, and finally the Endothelium, the inside lining. And so typically speaking in the regular Herpes infection, it only infects the superficial Epithelium, not the deeper layers. But typically, if you have this recurrence though, then it can then get into the deeper layers or go over them.
So for typical cases that come in, they have dendritic lesion on their cornea, you treat them with antivirals, typically then goes well and goes away. But you can get a recurrence of these. Just like people get cold sores, sometimes, frequently this can happen in the eye, too. And maybe in another thirty percent or forty percent, have a second episode in their lifetime and that’s all. But then other people who have it this recurrent after recurrent just like having a cold sore multiple times. The more times you have this happen then it tends to happen that the infection gets into the deeper Stroma layers of the cornea. Then it starts scarring the cornea and depending on where it’s located on the cornea, the south to the peripheral part of the cornea then you might not get any visual symptoms. But if this lesion is happening right at your pupil area, then if this scarring occurs to your cornea and your Stroma, then you do start losing vision.
So some people can have significant vision loss from Herpes infections of their eye. And so when it gets to the deeper layer now, instead of being dendritic, we’re now talking Disciform Herpes Keratitis. And so that’s treated with actually steroids. So you still have to be on antivirals. But then we add steroids to it once the Epithelium is healed in and now we just have Stromal activity then we put people on steroids to calm that down.
One thing that can happen is if someone is placed on steroids and they have a history of Herpes infections in their eye, then they can actually cause a Herpes infection to pop out. So someone who has a history of a Herpes infection in an eye, you don’t wanna use the steroids in their eye unless you have to. If there are some conditions you have to treat it then, when you do, you need to add the antivirals on top of that so that way you can protect them from getting a recurrence of the Herpes infection.
So the gentleman who came in, we’re treating him with antiviral medication in his eye and also we’re getting ready to start him on steroids to try to calm the stromal deeper layers down. If someone gets recurrent infections of their eye, then the next thing is, is a lot of townspeople put these people on systemic antivirals that you see advertised on TV sometimes and that is done and hopefully so people don’t get recurrences in their eye because you can’t keep having remissions.
So if you have any questions Herpes infection in your eye or any other eye problems, you can always contact us through the website. If not, may God grant you with healthy eyes and great vision.