Atlas of Ophthalmology

Acute Herpetic Keratitis in a Patient with Pneumococcal Meningitis (Fluorescein Stained Anterior Segment Photograph)

Cornea -> Keratitis, Keratouveitis (Infectious/Non-Infectious/Neuroparalytic/Parasitic) -> Disciform/Stromal/Interstitial/ Parenchymal Keratitis
Patient: 50 years of age, male, BCVA cc 0.4. Ocular Medical History: diminuishing vision. General Medical History: acute pneumococcal meningitis. Main Complaint: decreased vision. Purpose: to demonstrate signs of an acute keratitis in a patient with pneumococcal meningitis. Methods: Anterior Segment Colour Image, Fluorescein Stained Anterior Segment Photograph. Findings: Colour Image of Anterior Segment: epithelial and stromal opacification. Fluorescein Stained Anterior Segment Colour Image: typical signs of a herpetic epithelial keratitis. Discussion: HSV can cause stromal opacification and is the leading cause of infectious blindness in the developed world (1). Herpes simplex virus (HSV) is associated with a variety of ocular diseases, including epithelial and stromal keratitis. Types of expression include epithelial keratitis, stromal keratitis, and endothelial keratitis (2). Acyclovir 0.3% ointment serves as a selective agent and is a first-line topical drug for acute HSV keratitis. Literature: (1) Farooq AV, Shukla D. Herpes simplex epithelial and stromal keratitis: an epidemiologic update. Surv Ophthalmol. 2012 Sep;57(5):448-62. (2) Seitz B, Heiligenhaus A."Herpetic keratitis". Various expressions require different therapeutic approaches. Ophthalmologe.2011 Apr;108(4):385-95.

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