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31 Cards in this Set
- Front
- Back
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T or F humans are the only host for herpes simplex?
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true
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how is HSV transmitted?
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by direct contact with an infected individuals
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describe the difference b/t HSV 1 and HSV 2.
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HSV 1 is above the waist and is the leading ocular type and the leading cause of infectious blindness in the United States
HSV 2 is below the waist (genital) and is rarely ocular |
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what percentage of healthy adults in the US carry HSV 1?
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98% Although ocular involvement is rare.
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what are some things that you need to look at (ddx) when thinking about a diagnosis of herpes.
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is it bacterial or viral
PCF or EKC or could it be herpes zoster. |
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HEDS I resulted in what 3 outcomes
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1. prednisolone phosphate drops had faster resolution of keratitis than the placebo
2. No apparent benefit in the addition of oral acyclovir to the treatment regimen of topical steroid and antiviral. 3. showed that there could be a bennifit contrary to 2 but it was not significant. |
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HEDS II resulted in what?
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1. acyclovir added to the antiviral treatment of trifluridine was not beneficial.
2. acyclovir reduced the chance of reccurance by 41% in people that had no current infection to begin with. |
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what is the more sever form of HSV?
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stromal keratitis.
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if there is PEE or a dendrite on the cornea due to HSV what drug should be used and at what dose?
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trifluridine t.i.d to q.i.d for PEE or q2h 9 gtts/day max for dendrite.
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what is the maximum amount of days you can use trifluridine and why?
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21 day max b/c of corneal toxicity.
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when should a person that has been diagnosed with HSV, dendrites, or PEE been seen for a follow up?
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3 to 5 days. look for secondary bacterial infection, preceptal cellulitis, or stromal involvement.
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the HSV disease becomes latent in the ganglion of the trigeminal nerve. what sets it off to become active again?
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trauma, temp, stress...
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where can HSV reactivate at?
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usually the cornea, sometimes anterior uvea and cornea, conjunctivitis, lids, or gingivostomatitis (cold sores)
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what is the pain level like for a pt with HSV?
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the first outbreak could be painful but in later episodes herpes causes corneal hypoesthesia. use floss to test.
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is HSV unilateral or bilateral or could it be either?
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usually unilateral.
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terminal end bulbs on the dendrites are associated with what kind of herpes?
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HSV 1
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how do the dendrites begin their formation?
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As PEE that coalesce.
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what should you stain the cornea with if you suspect HSV?
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rose bengal or naFl
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if a person has a corneal ulceration due to HSV what other major problem with the anterior of the eye should be looked for?
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anterior uveitis. you should cycloplege the patient for their comfort.
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sometimes edema can accompany HSV infections that have ulcerated, what steroid should be used to help this?
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NONE. trick question this is never done when there is an ulceration.
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what oral drug could you consider if the infection is very sever?
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oral acyclovir
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while treating stromal keratitis it is okay to treat with steroids, true or false and why?
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true but only if the epithelium is intact.
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what is a non infectious keratitis that is a chronic ulcer secondary to epithelial dendriform keratitis. there is a lack of healing due to damage to the basement membrane or drug toxicity (trifluridine). there may be an ulcer with raised, rounded edges and it stains with rose bengal.
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Metaherpetic/Trophic keratitis
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what is a good treatment for metaherpetic/trophic keratitis?
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1. remove all potentially toxic agents!
2. promote epi healing - lubrication, hypertonics, and bandage CL. 3. recommended to refer to a corneal specialist. note: you could also give an antibiotic to prevent infection. |
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1. when a patient experiences many previous attacks of recurrent epithelial herpes or had epi herps treated with steroids. edema and infiltration begins to move in to the stroma, what is this called. 2. what is it called if vascularization also occurs?
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called stromal keratitis. If stromal vascularization also occurs then it is called interstitial keratitis.
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what is the general treatment for stromal keratitis? if no ulcerization
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a. trifluridine 1% 1gt qid
b. prednisolone acetate 1% 1gt qid c. homatropine if anterior uveitis is present. remember that steroids are ok if the epi is intact. |
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what is the treatment for stromal keratitis if the there is ulcerations on the cornea.
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best if the is re epithelialization noted before steroid use. then load them with antiviral (trifluridine 1% gt qid)24 to 48 hours before steroid use. then use prednisolone acetate 1% 1 gt qid and homatropine if there is anterior uveitis.
-prognosis is poor - refer to corneal specialist. |
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when using steroids for any treatment what should you watch for?
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elevated pressures and cataracts.
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what keratitis is described as an area of stromal edema (usually round in shap) with associated uveitis and can arise without epithelial defect being present?
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disciform keratitis.
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with disciform keratitis it is suspected that it is a viral reactivation of keratocytes and endothelium, but it may also be a hypersensitivity reaction of what type?
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IV
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does the use of acyclovir ointment use on the lips for cold sores reduce the severity of an out break, prevent recurrence or both?
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only reduce the severity of an outbreak.
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