Herpes corneae

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Classification according to ICD-10
B00.5 Herpes virus eye disease
H19.1 * Herpesvirus keratitis and keratoconjunctivitis
Dendritic keratitis and disciformis
ICD-10 online (WHO version 2019)

The herpes corneae ( herpes simplex corneae , herpes simplex keratitis, herpetic keratitis, keratoconjunctivitis herpetic) is primarily an inflammation of the cornea of the eye ( keratitis ) and possibly also the conjunctiva ( keratoconjunctivitis ) by a herpes simplex infection . The causative agent is predominantly the herpes simplex virus 1 (HSV-1), more rarely the HSV-2. The herpes corneae is the most common corneal inflammation in adulthood.

Clinical picture

The cornea is usually infected by reactivating a herpes simplex infection or after autoinoculation, for example of a herpes labialis . In addition to possibly visible blisters on the edges of the eyelids, corneal herpes is associated with the typical symptoms of keratitis: reddening, sensation of foreign bodies, "sand in the eye", photophobia and impaired vision. An increased secretion of tear fluid does not have to be present in herpes corneae . Depending on the depth of the affected layer, three types of corneal herpes can be distinguished:

  1. The superficial keratitis dendritica (epithelial keratitis), which only affects the epithelial layer of the cornea , in which the sensitivity of the cornea can be limited or lost.
  2. The deeper disciform keratitis (stromal keratitis) affecting the stroma , in which the epithelial layer remains intact and disc-shaped infiltrates are visible in the stroma.
  3. Endothelial keratitis or uveitis , which is also caused by viruses floating into the aqueous humor in more severe cases . This shape causes swelling of the endothelial cell layer at the back of the cornea and can lead to secondary glaucoma .

Diagnosis

The diagnosis is initially made based on the clinical appearance and the recurrent course. After staining with fluorescein and viewing in a slit lamp (or even with the naked eye), typical tree-like branches ( Greek δένδρον: tree) can be seen on the corneal surface in dendritic keratitis , which are conclusive for the diagnosis of this form. Another indication is the reduced corneal sensitivity. The diagnosis can only be confirmed by direct pathogen detection using PCR from a corneal swab. Serological detection methods are useless in herpes corneae .

If a clear diagnosis cannot be made, a corneabiopsy or a puncture of aqueous humor should be considered.

Differential diagnosis

Possible differential diagnoses include varicella-zoster keratitis in herpes zoster of the ophthalmic nerve or non-viral causes of keratitis. When viewed superficially, the symptoms can also be confused with those of acute keratoconus .

therapy

Therapy consists in the local application of antivirals as eye drops or eye ointments . Aciclovir and trifluorothymidine are initially effective in a higher dose for three days, then in the usual dose for a further ten days. Long-term local therapy with antivirals can damage the epithelial layer of the eye. Glucocorticoids are contraindicated in all forms of herpes corneae , as they inhibit the local immune system and promote the spread of the virus. Prevention of recurrence should be considered with long-term administration of acyclovir in the case of frequent occurrences and severe courses.

literature

  • R. Marre, T. Mertens, M. Trautmann, E. Vanek: Clinical Infectiology . Munich Jena 2000 p. 248ff ISBN 3-437-21740-2
  • J. Collier et al .: Oxford Handbuch der Klinischen Medizin 2 , Bern, Stuttgart, Toronto 1991, p. 496 ISBN 3-456-81999-4