Posters

Herpes simplex virus stromal keratitis and endotheliitis: case report

Poster Details

First Author: J.Pradas SPAIN

Co Author(s):    C. Schell   S. Elnayef   M. Asaad   B. Rodríguez           

Abstract Details

Purpose:

To report an eye with corneal endotheliitis and increased intraocular pressure in which the trabeculum did not demonstrated immunoreactivity for herpes simplex virus.

Setting:

Consorci Sanitari de Terrassa

Methods:

HSV infection the inflammation it induces can affect nearly every ocular tissue. In cases of corneal involvement, the epithelium, stroma, or endothelium may be affected. Both herpes stromal keratitis (HSK) and HSV endotheliitis can present clinically with photophobia, vision loss, and a slit lamp examination of the eye revealing stromal opacity and, therefore, may be difficult to distinguish.

Results:

A 52-year-old woman presented with photophobia and vision loss. The best-corrected visual acuity of the right eye was 0.02, an increased intraocular pressure of 42 mmHg, keratic precipitates, corneal stromal edema and with no anterior chamber inflammatory reaction. Funduscopy showed a normal optic disc but poorly defined details. One week treatment with topical beta-blocker and steroids did not improve the syntoms, until systemic steroids were iniciated aswell as oral acyclovir, therefore an aqueous humor polymerase chain reaction for Herpes Simplex Virus was made showing no results. Even when ocular hypertension was reduced, the cornea descompensation was inevitable.

Conclusions:

The origin of herpes virus in corneal endothelitis is unknown. Current findings suggest that Herpes simplex virus may cause trabeculitis and increased intraocular pressure in patients with corneal endotheliitis. The pathophysiology of HSK is complex and remains incompletely understood. Current data suggests that CD4 T cells of the adaptive immune system are required for the development and maintenance of HSK. Therefore the management of acute HSK and HSV endotheliitis is aimed at inhibiting viral replication with oral or topical antiviral medications and reducing inflammatory damage with topical corticosteroids

Financial Disclosure:

None