HERPES SIMPLEX DISCIFORM KERATITIS

These are photographs of the eyes of a 32 year old patient with herpes simplex disciform keratitis. The photo below is of the normal left cornea.

The photo below shows what the normal left eye looks like with fluorescein dye and red-free light. All you can really see is the tear film along the upper and lower lid, but there is no other staining.

The picture below shows the diseased right cornea with stain. There are bright dots associated with damage to surface corneal cells. There are darker spots corresponding to individual surface cells that are swollen.


The picture below is the diseased right eye showing extreme swelling of the cornea. The lines are folds on the back surface of the cornea that occur when the cornea becomes swollen. The cornea is thick (about 689nm thick compared to the normal left eye of 499nm). A swollen cornea also begins to become cloudy.

The photo below shows the well-demarcated edge separating normal cornea from swollen cornea. The disc appearance gives the disease it’s “disciform” name.

I started this patient on aggressive topical antiviral and anti-inflammatory medication, which she’ll need to be on for at least a month before I taper the dosage down.
Herpes Simplex Virus is a very common virus which most people harbor. For most people it causes no or mild symptoms. But in some people it can cause cold sores or active cornea disease. This particular case of “disciform” keratitis is actually not from active infection, but from inflammatory reaction to the virus’ presence.

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