CIBA Vision Ophthalmics - Digital Grand Rounds
Digital Grand Rounds Program - Answer/Discussion
This is a Herpes Simplex Viral (HSV) Keratitis with a geographic ulcer. We are used
to seeing the typical dedritiform appearing lesion, but frequently these lesions do present in the fashion seen here. One needs to always be suspicious of HSV. Follicles, preauricular adenopathy and drecreased corneal sensation are all hallmarks of HSV keratitis. Viroptic drops, 8 times a day as well as oral Acyclovir 200 mg, 5 times a day are both valid treatments. Viroptic is the gold standard, but is very toxic, and may cause significant keratopathy; often masking the healing keratitis from the HSV. If not careful, permanent scarring may result from Viroptic alone.
Many corneal specialists elect to use oral Acyclovir instead of Viroptic because it is just as effective as Viroptic, but without the toxic corneal effects of Viroptic. Oral Acyclovir is tolerated very well in the body with minimal side effects.
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