II. Epidemiology
- Outbreaks in winter and early summer
III. Symptoms
- Previous history of Herpes Keratitis
- Coexisting Fever Blister (herpetic rash) on lip or upper face
- Recent Upper Respiratory Infection
- Absent history of Corneal Trauma
- Severe Eye Pain
- Photophobia
- Eye Discharge
- Gritty Sensation in eye
IV. Signs
- Unilateral inflammation of Conjunctiva and Cornea
- Dendritic Ulcers on Fluorescein staining of Cornea (consider rose bengal strips if available)
- Reduced Corneal sensitivity
- Preauricualar node (anterior to tragus)
V. Complications
- Corneal Ulcer and scarring with obscured Vision
VI. Management
- Urgent Ophthalmology referral
- Consider Hospital admission
- AVOID Topical Steroids
- Topical Antivirals
- Ganciclovir 0.15% ophthalmic gel (Zirgan)
- Trifluridine 1% drops (Viroptic)
- Systemic Acyclovir or other Antiviral Agents
VII. References
- Williams (2017) Crit Dec Emerg Med 31(2): 3-12
- Pflipsen (2016) Am Fam Physician 93(12): 991-8 [PubMed]