Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Herpetic Keratitis and Iritis


History of Present Illness (HPI)

A 39-year-old man with no significant past medical history complains of 2 days of tearing, light sensitivity, and blurry vision in his left eye (OS). It started first with some foreign body sensation and has progressed since then. His other eye is fine. He denies getting anything in the eye or being hit in the eye and denies contact lens use.

Exam
OD OS
Vision 20/20 20/40+
IOP 12 25
Lids and lashes: Normal Normal
Sclera/conjunctiva: White and quiet Trace injection
Cornea: Clear See Fig. 9.1
AC: Deep and quiet 1+ white cell
Iris: Flat Flat
Lens: Clear Clear
Anterior vitreous: Clear Clear

Dilated Fundus Examination (DFE)
Nerve: Normal, cup-to-disc (c/d) 0.3 Normal, c/d 0.3
Macula: Good foveal reflex Good foveal reflex
Vessels: Normal caliber and course Normal caliber and course
Periphery: Unremarkable Unremarkable

Fig. 9.1, Color slit lamp photograph of the left eye under normal illumination shows a particularly long dendriform lesion on the corneal epithelium nasal and superior to the visual axis. A few stellate keratic precipitates (KPs) were noted, which are less well visualized in this image.

Questions to Ask

  • Do you have any history of cold sores?

  • Have you had previous episodes like this one?

  • Do you have any vesicular rashes on your head or elsewhere on your body?

He responds that he has had cold sores from time to time. He has no rashes. He has never had an episode like this.

Assessment

  • Herpetic epithelial keratitis with iritis OS

  • Ocular hypertension OS secondary to herpes

Differential Diagnosis

  • Herpes simplex virus (HSV) 1 (more likely) or 2

  • Varicella zoster virus (VZV)

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