What Is Herpes Keratitis?

Herpes zoster ophthalmicus can be combined with blephaeritis, conjunctivitis, keratitis, scleritis, uveitis, retinopathy (acute retinal necrosis), and optic neuritis. Herpes zoster keratitis can occur in 60% of these cases, causing corneal scars that severely affect vision. There is a growing tendency these days and it is worth vigilant.

Herpetic keratitis

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Herpes zoster ophthalmicus can be combined with blephaeritis, conjunctivitis, keratitis, scleritis, uveitis, retinopathy (acute retinal necrosis), and optic neuritis. Herpes zoster keratitis can occur in 60% of these cases, causing corneal scars that severely affect vision. There is a growing tendency these days and it is worth vigilant.

Chinese Medicine Name

Herpetic keratitis

English name

herpes zoster keratitis

Affiliated Department

Department of Ophthalmology-Ophthalmology

Prevent

protect eyes

1.Precursive symptoms of shingles throughout the body include general malaise, fever, chills, and painful linear blisters on the skin along the nerve-skin distribution area; associated with neuralgia. Extreme pain from tingles. Skin rash lasts for several months. Different from HSV, herpes zoster can invade permanent scars after dermal blister is cured.

2. Corneal manifestations Approximately 60% of ocular herpes zoster can cause corneal lesions. VZV is extremely susceptible to the first branch of the trigeminal nerve. Keratitis occurs more often after the rash appears, especially when the herpes zoster appears on the nose or wing. Signs of invasion of the branch nerves must occur subsequently. Keratitis and iritis are manifestations of keratitis, which are mainly of the following types:

(1) Superficial coarse keratitis: It is the earliest manifestation of herpes zoster keratitis. Within a few days after the rash appears, the corneal surface appears coarse and slightly higher than the corneal surface. The cloud point mostly occurs on the peripheral surface of the cornea. There are sticky secretions that show irregular coloring of fluorescein. Tiger red staining is more obvious. No ulcers are formed after shedding. These irregular cloud points are caused by the aggregation of turbid epithelial cells, which may be the result of virus invasion or the virus in epithelial cells. As a result of internal reproduction, virus inclusions can be detected in the nucleus of some cases.

(2) Subepithelial infiltration and coin-shaped keratitis: Superficial punctate keratitis can resolve on its own within a few days, and some quickly combine with each other to form subepithelial infiltration and further form nummular keratitis. The latter is considered It is a typical lesion of herpes zoster keratitis.

(3) Pseudodendritic keratitis: Dendritic keratitis associated with herpes zoster is very similar to HSV dendritic keratitis because of its morphology. The main difference is that its corneal lesions are slightly higher than the corneal surface. The degree of fluorescein staining is not as obvious as that of HSK in a groove-like depression; the end of the dendritic lesion does not have a terminal bulb like HSK, so it is called pseudodendritic keratitis to distinguish

(4) Mucous plaque keratitis: It is a special type of chronic keratitis. About 5% of herpes zoster patients will develop this kind of corneal lesions. The time of onset varies greatly from 7 days after the rash to It can appear in 3 years, but most of them appear in 2 to 7 months. The typical change is that the spotted lesions on the corneal surface are composed of micro-bumped mucus. Sometimes linear or dendritic lesions appear. The edges are usually multiple and can occur in The size and shape of any part of the corneal surface can be changed every day. Acetylcysteine can be dissolved by fluorescein. It is moderately pigmented. Tiger red staining is bright. The pathogenesis is not clear. It may be related to abnormal tear film, corneal sensory nerve paralysis, and incomplete eyelid closure. Factors.

(5) Neuroparalytic keratitis: With severe trigeminal neuralgia, all corneal sensation disappears, and it can last for several months to one year after the disease is healed, or even long-term non-recovery of long-term sensory disturbance. About 9% of patients Can cause severe occurrence of neurotrophic keratitis can lead to corneal ulcer secondary bacterial infection with corneal abscess or anterior chamber pus.

(6) Disc keratitis: After a few months, the subepithelial infiltration can develop deep into the stroma to form keratitis or disc keratitis with slit lamp microscopy. The infiltration and swelling of the elastic membrane folds of the corneal edema will increase after the cornea is examined. Lipid-like deposits are often left on the posterior corneal wall in thick turbid areas. Prolonged non-absorption may be an abnormal metabolite of corneal stromal cells (Keratocyte). This can be distinguished from discotic keratitis caused by HSK and vaccinia virus. Corneal uveitis or keratoendothelitis (a drop-shaped cornea on the corneal endothelium can be detected by specular reflection).

It is usually not difficult to diagnose the unique signs of the skin, eyes and cornea. Atypical rashes are often misdiagnosed. HSK The author believes that VKV should be suspected when keratitis or other eye signs have the following characteristics Previous A history of unilateral facial rash Residual scars or dark brown deposits in the area Atrophy of the iris Anterior chamber role pigmentation (more pigmented than other uveitis).

General treatment: 1. Pay attention to protect eyes and avoid trauma. 2. If there is varus or trichiasis and scratched cornea, it should be corrected in time. 3. Chronic dacryocystitis threatens corneal safety and should be treated as soon as possible. 4. Treatment of local and systemic infections. Strengthen nutrition and improve body resistance. 5. If there is danger of perforation, give a semi-liquid food and rest in bed. Treatment of ulcer scarring is the same as corneal scarring.

Intensive treatment: 1. Use cautery or cryotherapy. 2. Wear a soft contact lens, or scrape off the necrotic tissue on the edge of the corneal ulcer, and then apply bioadhesive. 3. Intraocular injection or subconjunctival injection of own blood, placental globulin, etc.

Local treatment: 1. Control infection: apply antibacterial solution and eye sacrifice locally, if necessary, combine subconjunctival injection or systemic sacral injection. Deep keratitis can be treated with cortical eye drops. 2. Mydriasis: Mydriasis is fully dilated with the solution. If it is a marginal ulcer, or if it will be perforated, it should be used with caution. 3. Local hot compress. Protect eyes from strong light irritation

Diet should eat more vegetables and fruits rich in vitamins and fiber. Eat legumes, soy products, lean meat, eggs and other high-calorie, high-protein foods to facilitate corneal repair. You should quit smoking and drinking, and do not eat fried, spicy, fatty and sugary foods. Spiritual recuperation is very important for this disease. The most important thing is to avoid depression and anger, so as not to aggravate the liver anger, which is not conducive to rehabilitation. But it is also not appropriate to talk and laugh too much, and to relax and calm.

Strengthen nutrition, eat more foods rich in vitamins A, B, C, such as liver, carrots, fruits, vegetables, etc., to enhance the body's resistance. Cultivate habits of cleanliness and hygiene, do not rub your eyes with dirty hands and dirty handkerchiefs, and wash your face with regular boiling disinfection to prevent repeated infections and aggravate the disease, causing bad consequences.

Herpes zoster keratitis should pay attention to prevention. Especially in recent times, wearing keratoscopes (contact lenses) has been increasing. Without hygiene and improper care, keratitis is prone to occur. After inflammation of the cornea, you should go to the hospital for examination and treatment in time, so as not to delay, so as not to affect vision. Patients should take adequate rest. Keep your eyes in contact with fresh air for recovery. Listening to more relaxing music will also help relieve eye pain and local irritation.

To prevent shingles keratitis, care should be taken to establish a healthy lifestyle. Because patients with vesicular keratitis are poisoned for life, any factors that affect immune fluctuations will cause recurrence of old diseases. Patients should live regularly and avoid incentives such as staying up late, drinking, overeating, colds and fever, and sun exposure to reduce the risk of recurrence of old diseases. Once the old disease recurs, it is necessary to go to the hospital in time to receive the doctor's diagnosis and consultation, and don't use it rashly, so as not to complicate the condition and increase the difficulty of treating the disease.

To prevent shingles keratitis, you should eat more vegetables and fruits rich in vitamins and fiber in your diet. Eat legumes, soy products, lean meat, eggs and other high-calorie, high-protein foods to facilitate corneal repair. You should quit smoking and drinking, and do not eat fried, spicy, fatty and sugary foods. Spiritual recuperation is very important for this disease. The most important thing is to avoid depression and anger, so as not to aggravate the liver anger, which is not conducive to rehabilitation. But it is also not appropriate to talk and laugh too much, and to relax and calm.

Strengthen nutrition, eat more foods rich in vitamins A, B, C, such as liver, carrots, fruits, vegetables, etc., to enhance the body's resistance. Cultivate habits of cleanliness and hygiene, do not rub your eyes with dirty hands and dirty handkerchiefs, and wash your face with regular boiling disinfection to prevent repeated infections and aggravate the disease, causing bad consequences.

The cause of herpes zoster keratitis is more complicated. Varicella virus and herpes zoster virus (VZV) are the same virus. Different immune states can cause chicken pox or herpes zoster. In the nerve cells lurking in one or more spinal ganglia or in the cells of the brain sensory ganglia, when the body's immunity decreases, the virus reactivates and descends along the sensory nerve fibers to the skin. Proliferation occurs in a sensory nerve and eye area. Herpes is most common in the first branch of the trigeminal nerve.

Herpes zoster keratitis is caused by recurrent infection of varicella-zoster virus (VZV), which lurks in the trigeminal ganglia when the immune function of the body's cells declines or is induced by other external stimuli. Patients with immunodeficiency, such as patients with AIDS, cell transplant patients, and patients with a recent history of cancer and a history of trauma, are also prone to relapse and infect VZV that is latent in the body.

Differential diagnosis: The differential diagnosis of herpes zoster keratitis needs to be differentiated from HSK, mainly from the diagnosis of the etiology. The morphology of chickenpox-zoster virus caused by a small dendritic keratitis caused by chickenpox-zoster virus Nodules-like swelling at the ends.

1. Conjunctival and corneal epithelial scrapings were performed in the acute phase of epithelial scrapings to check macrophages and eosinophilic inclusions in the nucleus, but they could not be distinguished from HSV.

2. Virus isolation When necessary, isolate the virus from the conjunctival sac and the skin blister to isolate the virus. Rabbit corneal inoculation does not cause disease. This can be distinguished from HSV.

3. Determination of serum neutralizing antibodies 4 days after the disease can be measured 2 weeks after the peak reached 1 year and fell to undetectable levels.

4. Fluorescein-labeled antibody staining technique Take the lesioned corneal epithelium scrape and directly stain with fluorescein-labeled antibody for examination. It can be proved that there is a virus infection in the infected cells. Because of the specificity of the labeled fluorescein-labeled antibody, it can be distinguished from HSV.

5. Complement binding test The increase in serum anti-VZV antibody titer in chickenpox patients gradually decreased to a level that can only be detected in the recovery period of 6 to 12 months. The high titer VZV antibody anti-HSV antibody was found using the complement binding test. A negative result can be judged to be caused by VZV infection.