HEAD, EYE, EAR, NOSE, AND THROATEMERGENCIESSYMPTOMS/EXAM
■ Severe pain, foreign body sensation
■ Photophobia, blurred vision
■ Conjunctival hyperemia, lid edema
■ Localized whitish corneal defect with infiltrate (slit lamp)
■ Anterior chamber reaction with cells and flare
TREATMENT
■ Discontinue contact lens use.
■ Eye patching is not recommended.
■ Good analgesics
■ Immediate ophthalmology consult is indicated. Ophthalmologist may wish
to Gram stain and culture the ulcer so check if topical antibiotics should be
initiated.
COMPLICATION
Corneal perforation
Herpes Simplex Keratitis
■ Occurs as a primary or recurrent infection of HSV (usually type I), the
virus colonizes the trigeminal ganglion of CN V.
■ Recurrences are associated with sunlight exposure and immunodeficiency
(including the use of topical steroids).
■ Skin and mucocutaneous lesions are typically seen in primary infection;
dendritic keratitis with possible corneal scarring occurs with recurrences.
(See Figure 14.35—be able to identify this pattern on pictorial.)
SYMPTOMS/EXAM
■ Ocular pain, photophobia, foreign body sensation
■ Visual acuity may be decreased.
■ Decreased corneal sensation
Hypopyon, a layered
accumulation of inflammatory
cells in the anterior chamber,
may be seen with corneal
ulcers and iritis.FIGURE 14.35. Dendritic pattern of herpes simplex keratitis. Be able to identify this
pattern on pictorial.
(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB. Atlas of Emergency
Medicine, 2nd ed. New York: McGraw-Hill, 2002:57.)