Differential Diagnosis - Pacific University

5/29/2012
Non-Necrotizing ISK
• Treat with topical anti-viral (Viroptic or Zirgan) and Pred
Acetate 1% with equal frequency until the steroid is
tapered down to BID or QD
• Add oral acyclovir AFTER the virus is inactive without
treatment for 30 days – 400mg BID x 1 year
Necrotizing ISK
• Perforation likely eminent requiring a corneal transplant
• Use oral acyclovir to prevent graft rejection
• Zirgan should also be considered to prevent rejection
• Restasis and Avastin are new treatments to consider as
well
1. Latham , Emi. "Hyperbaric Oxygen Therapy." Medscape Reference.
WebMD LLC, 19052010. Web. 27 Apr 2012.
.
2. Onofrey B, Skorin L, Holdeman N. Ocular Therapeutics Handbook: A
Clinical Manual. 3. Philadelphia; Lippincott Williams & Wilkins, 2011.
198-204. Print.
3. Sugar, Alan. "Herpes Simplex Keratitis." UpToDate. N.p., 11/11/2011.
Web. 30 Apr 2012. .
4. Schwartz GS, Harrison AR, Holland EJ. “Etiology of immune stromal
(interstitial) keratitis.” Cornea. 1998; 17(3):278-81
5. Krachmer J, Mannis M, Holland E. Cornea. 2. 1. Philadelphia: Elsevier
Mosby, 2005. 1048-1066. Print.
6. Dr. Hetrick’s book
7. Sowka J, Gurwood A, Kabat A. “Immune Stromal (Interstital) Keratitis.”
Handbook of Ocular Disease Management. N.p.; n.d. Web. 4 March 2012.
.
8. Wang, J. “Ophthalmologic Manifestations of Herpes Simplex Keratitis.”
Medscape Reference. WebMD LLC., 18 Nov 2010. Web. 3 March 2012.
.
9. Wilhelmus KR, Gee L, Hauck WW, et al. “Herpetic Eye Disease Study. A controlled trial
of topical corticosteroids for herpes simplex stromal keratitis.” Ophthalmology.
1994;101(12):1883-95.
10. Barron BA, Gee L, Hauck WW, et al. “Herpetic Eye Disease Study. A controlled trial of
oral acyclovir for herpes simplex stromal keratitis.” Ophthalmology.
1994;101(12):1871-82.
11. Herpetic Eye Disease Study Group. “Predictors of recurrent herpes simplex virus
keratitis.” Cornea. 2001;20(2):123-8.
12. Herpetic Eye Disease Study Group. “Oral acyclovir for herpes simplex virus eye
disease: effect on prevention of epithelial keratitis and stromal keratitis.” Arch
Ophthalmol. 2000;118(8):1030-6.
13. Herpetic Eye Disease Study Group. “Acyclovir for the prevention of recurrent herpes
simplex virus eye disease.” N Engl J Med. 1998;339(5):300-6.
14. Knickelbein J, Buela K, Hendricks R. “Herpes Stromal Keratitis: Erosion of Ocular
Immune Privilege by Herpes Simplex Virus.” Future Virology, 5.6 (2010):699-708. Print.
15. Saxena S, Sinha N. Keratoplasties- Surgical techniques and complications.
Shanghai:InTech, 2012. 127-134. Print.
16. Wilhelmus KR, Dawson CR, Barron BA, et al. “Risk factors for herpes simplex virus
epithelial keratitis recurring during treatment of stromal keratitis or iridocyclitis.” Br J
Ophthalmol 1996; 80:969-72.
1-3) Latham , Emi. "Hyperbaric Oxygen Therapy." Medscape
Reference. WebMD LLC, 19052010. Web. 27 Apr 2012.
.
4-8) Photos obtained from Wainwright Memorial VAMC Walla Walla,
WA 03/24/12
9-12)Photos obtained from various cartoon monster websites
13,14)Photos obtained from Pacific Cataract and Laser Institute
Kennewick, WA 03/14/12
15)Herpes Simplex Stromal Necrotizing Keratitis- American
Academy of Ophthalmology
16)Trigeminal Nerve- wikipedia
17)Multinucleated giant cells-
18)Elvis photo-
19) Conjunctival Flap photo-
Coursebook Page 19 of 139
10