The Chameleon of Herpetic Keratitis - Diagnosis and Therapy

Abstract

In Europe, herpes simplex virus type I (HSV) is a common cause of keratitis. The disease may be well treated if the ophthalmologtist is aware of the various types of clinical expressions of this typical unilateral chameleon, and treatment is adjusted accordingly. Types of expression include: (i) epithelial keratitis (dendritica/geographica), (ii) stromal keratitis (necrotising vs. non-necrotising = "interstitial keratitis"), (iii) endotheliitis (= "disciform keratitis"), (iv) so-called "metaherpetic keratitis" (= neurotrophic keratopathy), (v) (vascularised) corneal scars. In the acute phase, concomitant ocular hypertension should be treated predominantly without surgery (no prostaglandin analoga!). After keratoplasty and in cases of severe recurrences of herpetic keratitis, systemic aciclovir administration (2 × 400 mg/day) for at least one year is indispensable!