Herpetic keratoconjunctivitis and keratitis in children

Primary herpetic keratoconjunctivitis develops in the first 5 years of a child's life after primary infection with the herpes simplex virus. The disease is more often one-sided, with a long and sluggish course, is prone to relapse. It manifests itself in the form of catarrhal or follicular conjunctivitis, less often - vesicular-ulcerative. Detachable is slight, slimy. Characterized by recurrent eruptions of herpetic vesicles with the subsequent formation of erosions or ulcers on the conjunctiva and the edge of the eyelid, covered with delicate films, with reverse development without scarring. Severe systemic manifestations of herpetic infection, for example encephalitis, are possible.

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Herpetic keratitis

Development of the clinical picture of the disease is preceded by hypothermia, febrile conditions; is not characteristic of the lesion of the mucous membrane and skin of the eyelids; as a rule, one eye is affected. There is a decrease in the sensitivity of the cornea, a slow regeneration of the foci, a weak tendency to neoplasm of the vessels, a tendency to relapse.

Herpetic keratitis is epithelial (the most common type of ophthalmoherpes is 36.3%): tree (vesicular, star, point), tree-like with stromal lesion, cartilaginous. The earliest signs of viral epithelial damage to the cornea are point epithelial opacities or small vesicles. Fusing, bubbles and infiltrates form a kind of figure of a tree branch.

Herpetic keratitis stromal is less common, but it is referred to a more severe pathology. In the absence of ulceration, it can be focal, with the localization of one or more foci in the superficial or middle layers of the stroma of the cornea. With stromal keratitis, an inflammatory process of the vascular tract almost always occurs with the appearance of precipitates, the folds of the Descemet's membrane.

For discoid keratitis is characterized by the formation of a round infiltrate in the middle layers of the stroma in the central zone of the cornea. With discoid herpetic keratitis, there are two signs that are important in differential diagnosis: the presence of precipitates (sometimes they are poorly visible due to corneal edema) and the rapid therapeutic effect of the use of glucocorticoids.

Herpetic ulcer of the cornea can be the outcome of any form of ophthalmoherpes when the necrotic process extends deep into the stroma of the cornea with the formation of a tissue defect. Herpetic ulcer is classified as a serious disease, characterized by a flaccid course, a decrease or lack of sensitivity of the cornea, and occasionally pain. When a bacterial or fungal infection is attached, the ulcer progresses violently, deepens, until the cornea is perforated. The outcome may be the formation of a fused belly with a fallen iris or penetration of the infection inside, endophthalmitis or panophthalmitis followed by the death of the eye.

With herpetic keratowaitis, there are phenomena of keratitis (with or without ulceration), but signs of vascular tract lesions predominate. Characterized by the presence of infiltrates in different layers of the stroma of the cornea. If ulceration occurs, it seizes the most superficial layers of the cornea; note the deep folds Descemet's shell, precipitates, exudate in the anterior chamber, newly formed vessels in the iris, posterior synechiae. Often develops bullous keratoiridocyclitis with the appearance of blisters and erosions in the epithelial cover, increased intraocular pressure in the acute period of the disease.

Treatment of herpetic keratoconjunctivitis and keratitis

• Antiherpetic drugs (acyclovir in the form of ophthalmic ointment 5 times in the first days and 3-4 times in the following).
• Interferons (ophthalmoferon) or interferonogens (aminobenzoic acid) 6-8 times a day (more efficient combination of topical application of acyclovir and interferons).
• Antiallergic (ketotifen, olopatadin or cromoglycic acid) 2 times a day and anti-inflammatory drugs (diclofenac, indomethacin) 2 times a day locally.

For herpetic keratitis additionally:

• mydriatica (atropine);
• stimulators of the regeneration of the cornea (taurine, dexpanthenol 2 times a day);
• tear-replacing drugs (hypromellose + dextran 3-4 times a day, sodium hyaluronate 2 times a day).

To prevent secondary bacterial infection - picloxidine or fusidic acid 2-3 times a day.

With the expressed edema of the cornea and ocular hypertension apply:

• Betaxolol (Betoptik), eye drops 2 times a day;
• Brinzolamide (azopt), eye drops 2 times a day.

Local use of glucocorticoid drugs is necessary for stromal keratitis and is contraindicated in keratitis with ulceration of the cornea. It is possible to use them after epithelialization of the cornea to accelerate the resorption of infiltration and to form more tender opacities of the cornea. It is safer to start installations with low concentrations of dexamethasone (0.01-0.05%), which are prepared ex tempore, or add the drug for parabulbar injections.

Depending on the severity and severity of the process, systemic antiviral drugs (acyclovir, valaciclovir) in tablets and for intravenous administration, systemic antihistamines are also used.