Differential Diagnosis - Pacific University

5/29/2012
Corneal thinning - secondary to chronic
inflammation
Corneal Scarring – secondary to stromal
neovascularization that can result in
profound vision loss**
Fibrosis, pannus, and lipid deposits from
stromal neovascularization
Occurs in 20-60% of eyes with recurrent HSV, and
90% of recurrent stromal keratitis 3,4
It does not usually move toward ulceration and
perforation
Untreated non-necrotizing ISK runs a self-limiting
course over several months; however if left
untreated severe vascularization and scarring
can result in profound vision loss thus treatment
is indicated 7
More severe form of herpetic stromal keratitis
• Manifests as dense, cheesy, yellow-white stromal infiltration
• Epithelial ulceration
• Stromal edema
• Dense vascularization
• Profound corneal thinning
• Possible perforation (major complication)**
The use of topical corticosteroids without antiviral
coverage may be a possible risk factor for its
development
It is much less common than the non-necrotizing type
Coursebook Page 15 of 139
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