Materiały źródłowe

• #1 Herpes Simplex Keratitis

  http://eyerounds.org/cases/160-HSV.htm

  Herpes simplex keratitis is the most common corneal infection in the United States. It is the number one cause of corneal and infectious blindness and a leading indication for corneal transplantation. The diagnosis of HSV keratitis is primarily clinical, although additional tests may be useful in providing confirmation, but never exclusion. The Tzanck (Giemsa) smear of multinucleated epithelial cells is a quick test with high specificity but low sensitivity. Viral culture remains the gold standard with high sensitivity for detection of the virus. Other tests include a viral antigen assay and polymerase chain reaction (PCR), which has the highest specificity. It should be noted that these tests are only positive when live virus is present as seen in HSV epithelial keratitis and cannot be used to diagnose, or exclude, active disease caused by immunologic reactions against HSV triggered by prior infections, which is typically the case for HSV stromal keratitis.

• #1 Herpes Simplex Virus (HSV) Keratitis Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/1194268-workup

  Herpes simplex virus (HSV) keratitis remains primarily a clinical diagnosis based on characteristic features of the corneal lesion. […] Laboratory studies may help to confirm the clinical suspicion in cases lacking typical findings, but they are not readily available in most clinical settings. […] If the diagnosis is in doubt, however, laboratory diagnosis can be made using the following: Giemsa stain – Scrapings of the corneal or skin lesions show multinucleated giant cells. […] Papanicolaou stain – This shows intranuclear eosinophilic inclusion bodies. […] Viral culture. […] Immunohistochemistry looking for viral antigens. […] Polymerase chain reaction (PCR) assay. […] Epithelial scrapings with Giemsa stain may show multinucleated giant cells, resulting from coalescence of infected corneal epithelial cells and intranuclear viral inclusions.

• #1 Herpes simplex eye infections

  https://www.nhs.uk/conditions/herpes-simplex-eye-infections/

  A herpes simplex eye infection is a viral infection that can cause a painful, red eye. It’s also called eye herpes or ocular herpes. It’s important to get treatment because it can sometimes affect your sight. […] If a GP thinks you have a herpes simplex eye infection they’ll refer you to an eye specialist (ophthalmologist). You’ll usually be seen the same day so that you can start treatment quickly. […] Most infections will get better with treatment in a couple of weeks and will not permanently affect your eyesight. […] If treatment does not work or you keep getting the infections, your cornea (the transparent front part of your eye) might become scarred, causing sight loss. If this happens you might need to have a cornea transplant.

• #1 Information about Herpes Eye Disease and Other Herpes Viruses Including Chickenpox

  https://www.webmd.com/genital-herpes/eye-herpes

  How Is Herpetic Eye Disease Diagnosed? The two types of herpetic eye disease have different symptoms. One thing they have in common, however, is that they can both be very painful, because they affect the nerves directly. The problem is likely to be herpes zoster ophthalmicus if your doctor finds some or all of these symptoms: Pain in and around only one eye, Headache and fever, Redness, rash, or sores on the eyelids and around the eyes, especially on the forehead, A rash on the tip of the nose, Redness of the eye, Blurry vision, Swelling and cloudiness of the cornea. […] The problem is likely to be herpes simplex keratitis if your doctor sees these symptoms: Pain in and around only one eye, Redness of the eye, Feeling of dirt or „grit” in the eye, Overflowing tears, Pain when looking at bright light, Swelling or cloudiness of the cornea.

• #1 Herpes Simplex: Ocular Manifestations and Management

  https://eyesoneyecare.com/resources/herpes-simplex-ocular-manifestations-management/

  Gain a comprehensive understanding of how optometrists can identify and manage ocular manifestations of herpes simplex virus (HSV). […] The diagnosis of ocular herpes is primarily a clinical one. In some cases, polymerase chain reaction (PCR) testing may be done via a sample from the affected area. Additionally, serologic tests may be done to detect rising antibody (Ab) levels during primary infection; however, they are of no assistance for recurrent disease. The absence of HSV-Ab may help to serve as a negative predictive value to rule out HSV as the cause of disease. Therefore, a detailed ocular examination, including corneal sensitivity testing, is crucial for appropriate diagnosis and management. […] It is important to consider herpes if a patient is in less pain than what the clinical findings reveal. Suspect herpes if a patient is photophobic or has uveitis and high IOP. Finally, it is important to suspect a recurrent herpes infection when a patient has a prior history of herpetic eye disease.

• #1 Herpes Eye Disease

  https://myhealth.umassmemorial.org/Search/134,542

  Herpes eye disease is a group of eye disorders caused by infection with the herpes simplex virus (HSV). […] Your eye care provider (often an ophthalmologist) makes the diagnosis. This is done with a health history and a full eye exam. They may check your eye with a slit lamp microscope. This magnifies the surface and inside of your eye. Your provider will also likely place a dye on the surface of your eye. This lets them more closely examine your cornea. […] In rare cases, your provider might send a tiny bit of eye tissue to the lab to see if the virus is there.

• #1 Herpes Eye Disease

  https://healthlibrary.osfhealthcare.org/Library/Encyclopedia/134,542

  Herpes eye disease is a group of eye disorders caused by infection with the herpes simplex virus (HSV). […] Your eye care provider (often an ophthalmologist) makes the diagnosis. This is done with a health history and a full eye exam. They may check your eye with a slit lamp microscope. This magnifies the surface and inside of your eye. Your provider will also likely place a dye on the surface of your eye. This lets them more closely examine your cornea. […] Often you will not need any other testing. In rare cases, your provider might send a tiny bit of eye tissue to the lab to see if the virus is there.

• #1 Herpes Simplex Epithelial Keratitis – EyeWiki

  https://eyewiki.org/Herpes_Simplex_Epithelial_Keratitis

  Herpes simplex virus (HSV) is a very common, lifelong infection that often is asymptomatic. However, HSV can result in significant eye disease and is the most common cause of corneal blindness in the United States (US). […] The clinical diagnosis of HSV may be suggested by the presence of the multiple arborizing dendritic epithelial ulcers with terminal bulbs. The bed of the ulcer stains with fluorescein, while the swollen corneal epithelium at the edge of the ulcer typically stains with rose bengal. Several dendrites may also coalesce to form a geographic epithelial ulcer. […] The diagnosis of HSV is often made clinically; however, laboratory tests are available to confirm the diagnosis in more ambiguous and difficult cases (and in all cases of neonatal herpetic infections). Serologic testing may be performed but is usually not helpful in recurrent disease, as most adults are laterally infected with HSV. Thus, serum antibody testing is typically of limited use. However, conjunctival scrapings, impression cytology specimens, and scrapings from vesicular lesions on the skin may be tested by cytology, culture, or polymerase chain reaction (PCR) for the presence of HSV.

• #1 Herpes Simplex Keratitis – Eye Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/eye-disorders/corneal-disorders/herpes-simplex-keratitis

  Herpes simplex keratitis is an eye infection that involves the cornea (the clear layer in front of the iris and pupil) and is caused by herpes simplex virus. […] Doctors diagnose herpes simplex keratitis based on an examination of the person’s cornea and sometimes by swabbing the eye to identify the virus. […] To diagnose a herpes simplex infection, a doctor examines the eye with a slit lamp (an instrument that enables doctors to examine the eye under high magnification). During the examination, the doctor may put drops in the eyes that contain a yellow-green dye called fluorescein. The fluorescein dye temporarily stains the damage in the cornea a bright green, making it possible for the doctor to see a damaged area that is not otherwise visible. […] Sometimes, the doctor may swab the infected area to identify the virus, using either a viral culture or a nucleic acid amplification test (NAAT). In a viral culture, microorganisms in a sample of blood, body fluid, or other material taken from the infected area are grown in the laboratory for identification. NAATs are used to look for an organism’s unique genetic material, its DNA or RNA (which are nucleic acids). NAATs use a process that increases the amount of the bacteria’s DNA or RNA so that it can be more easily identified.

• #1 Herpes Simplex Keratitis: Managing the Masquerader

  https://www.reviewofcontactlenses.com/article/herpes-simplex-keratitis-managing-the-masquerader

  Herpes simplex keratitis (HSVK) is a condition that can frustrate both clinicians and patients alike. It has often been recognized as a clinical masquerader due to its occasionally mystifying and varying presentation. These variations can result in delayed diagnosis, which impacts the patients time and comfort as well as their overall visual outcomes. Eye care professionals must be able to recognize and treat HSVK efficiently to not only shorten the course of the disease but also reduce permanent corneal scarring and poor visual prognosis. […] Corneal sensitivity testing and a thorough slit lamp exam, which includes evaluation of the cornea and corneal staining, are key components in the diagnosis and management of HSVK. Corneal staining is a technique that uses fluorescein, lissamine green or rose Bengal stain to improve visualization of epithelial defects and virus-laden cells on the cornea. The hallmark sign of HSVK is a dendritic lesion with terminal bulbs. The main body of the lesion will stain with fluorescein while the terminal bulbs will stain with rose Bengal or lissamine green.

• #1 Herpes Simplex Virus (HSV) Keratitis Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/1194268-workup

  However, negative cytology results do not exclude HSV infection. […] Viral cultures obtained within several days of onset of disease and prior to antiviral therapy have a sensitivity of up to 70% and also allow for identification of the HSV subtypes. […] Various techniques (eg, conventional tube culture, shell vial assay, suspension infection method) are available. […] HSV-antigen detection tests, such as the enzyme-linked virus-inducible system (ELVIS), are very specific for detecting herpes infection, but they are limited by their lower sensitivity. […] Cell culture for confirmation of HSV is recommended when the ELVIS test result is negative. […] PCR assay using tear samples, corneal epithelium, anterior chamber tap, or corneal buttons may detect viral DNA in cases of herpetic keratitis or keratouveitis.

• #1 Herpes Simplex Eye Infections: Symptoms and Treatment

  https://patient.info/doctor/herpes-simplex-eye-infections

  Herpes simplex eye infections can be diagnosed through clinical examination and may not require further investigation following ophthalmological review. […] If there is doubt over the diagnosis, corneal or skin scrapings can be taken and a viral swab may be performed. […] Polymerase chain reaction (PCR) can identify minute quantities of herpes simplex viral DNA in tissue samples and tears. […] Real-time PCR may be a useful technique for rapid diagnosis of ocular HSV infection, particularly in the identification of aciclovir-resistant keratitis. […] Specialist diagnosis of ocular herpes simplex may be made by slit-lamp examination which may show corneal vesicles. […] Corneal or skin scrapings, or a viral swab, can be analysed by viral culture and/or polymerase chain reaction (PCR), to detect herpes simplex virus (HSV) DNA.

• #1 Herpes Simplex Virus (HSV) Keratitis Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/1194268-workup

  However, it does not distinguish between latent or active HSV infections. […] A study by Inoue et al indicated that an immunochromatographic assay (ICGA) kit developed for the identification of HSV is clinically useful in the diagnosis of HSV epithelial keratitis. […] The investigators found that the ICGA had moderate sensitivity and high specificity, showing positive results for 35 out of 75 patients (46.7%) diagnosed with epithelial keratitis and negative results for 39 out of 39 patients (100%) who did not have the disease.

• #1 Ocular Herpes: Symptoms and Treatments, Assil Eye Institute

  https://assileye.com/blog/ocular-herpes/

  Diagnosing ocular herpes infection of the eye […] Your eye doctor can be diagnosed during a routine eye exam. Identifying which virus is the culprit depends on your symptoms. Your eye specialist may want to take a fluid sample from the blisters and send it to the lab to confirm which form of herpes is present. […] […] Your eye specialist might also check the pressure inside your eye. In addition, your doctor might place fluorescein dye eye drops in your eye and examine it under ultraviolet light in order to check for damage to the surface of your cornea. Less commonly, herpes simplex virus may also infect the inside of the eye (Herpes Uveitis). […] It’s possible for ocular herpes and conjunctivitis (commonly known as pink eye) to be confused, especially in the early stages. Both conditions can present with redness, tearing, and discomfort in the eye.

• #1 Eye Herpes: Symptoms, Treatment, Causes, Preventions, Pictures

  https://www.emedicinehealth.com/eye_herpes/article_em.htm

  Herpes simplex keratitis is an infection of the cornea caused by the herpes simplex virus (HSV). Also known as eye herpes, this illness should be treated by a physician as complications can arise. […] The diagnosis of herpes simplex infection is often overlooked because symptoms usually resemble those of common conjunctivitis. Ocular pain is usually not a symptom of common conjunctivitis. […] The physical examination pertaining to the eyes may consist of checking your vision, visual inspection of the eye and its surrounding tissue, eye movements, visual fields (peripheral vision), and the pupil’s reaction to light. […] In herpes simplex keratitis, there is often a specific detectable abnormality, called a dendrite, on the surface of the cornea. The presence of a dendrite makes the diagnosis of herpes simplex keratitis extremely likely.

• #1 Eye herpes: Pictures, symptoms, and types

  https://www.medicalnewstoday.com/articles/321693

  For the most part, eye herpes affects the transparent front part of the eye. This condition is known as epithelial keratitis. […] If eye herpes affects the deeper layers of the cornea, it is known as stromal keratitis. This condition is more concerning to eye doctors because it can cause scarring on the cornea, which can permanently affect a persons vision.

• #1 Herpes simplex keratitis (HSK) – College of Optometrists

  https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/herpessimplexkeratitis_hsk

  Herpes simplex keratitis (HSK) is the most common ocular manifestation of herpes simplex virus (HSV) eye infection, usually the HSV-1 subtype. It is classified according to which layer of the of the cornea is affected, with epithelial keratitis accounting for 50% to 80% of HSK cases. This Clinical Management Guideline outlines the aetiology, signs, symptoms and evidence-based recommendations for diagnosing and treating HSK. It outlines pharmacological and surgical treatment options, and when referral may be appropriate. […] A new case, with involvement of the surface skin of the cornea only, will usually be treated by the optometrist with anti-viral eye ointment. In children, contact lens wearers and where the condition affects both eyes, same-day referral to the ophthalmologist is recommended. This is a condition which tends to recur from time to time. Recurrences involving only the surface skin of the cornea can often be managed by the optometrist, who will usually prescribe anti-viral eye ointment, but if this is not effective after a week, urgent referral to the ophthalmologist is recommended. If the vision has become badly affected by scarring of the cornea, a patient may be offered a corneal transplant.

• #1 Herpes Simplex Epithelial Keratitis – EyeWiki

  https://eyewiki.org/Herpes_Simplex_Epithelial_Keratitis

  Recent tear metabolomics profiling has identified novel potential biomarkers in epithelial herpes simplex keratitis (HSK). Zhang et al. reported that specific metabolic alterations, including changes in amino acids, lipids, and energy metabolism-related metabolites, were consistently observed in patients with active epithelial HSK compared to healthy controls. Key biomarkers such as decreased arginine and altered sphingolipid metabolism were strongly associated with disease severity. These findings suggest that noninvasive tear sampling combined with metabolomic analysis could serve as a complementary diagnostic tool to traditional clinical and molecular tests.

• #1 Herpes simplex keratitis: challenges in diagnosis and clinical managem | OPTH

  https://www.dovepress.com/herpes-simplex-keratitis-challenges-in-diagnosis-and-clinical-manageme-peer-reviewed-fulltext-article-OPTH

  Herpes simplex virus is responsible for numerous ocular diseases, the most common of which is herpetic stromal keratitis. […] The diagnosis of these lesions as the result of a recurrent herpes simplex virus infection can at times be problematic. Currently, herpetic stromal keratitis is diagnosed by its clinical presentation on the slit-lamp examination, but the literature does not always support the accuracy of these clinical findings. […] It is primarily diagnosed by its clinical presentation, but atypical presentation of the infection can impede accurate diagnoses and thus proper treatment. […] HSK is primarily diagnosed by its clinical presentation on the slit-lamp examination. Common symptoms include redness, discharge, watery eyes, irritation, itching, pain, and photophobia. […] Dendritiform epithelial lesions on slit-lamp examination are pathognomonic for keratitis. However, previous studies have shown that ocular lesions caused by cytomegalovirus, herpes zoster, adenovirus, and fungal infections have been misdiagnosed as HSK lesions.

• #1 Diagnosis and Treatment of Herpes Keratitis

  https://www.reviewofophthalmology.com/article/diagnosis-and-treatment-of-herpes-keratitis

  Diagnosis may be further challenged if the patient has other forms of ocular surface disease. […] Once the correct virus has been identified, treatments include oral and topical antivirals, and steroids. […] The treatment for epithelial disease is primarily antivirals. […] If it’s zoster, then there’s been some evidence that ganciclovir might work topically. […] Not to mention, if it’s stromal disease, topical medications don’t work. […] The efficacy of using antivirals prophylactically in HZO is the aim of the Zoster Eye Disease Study. […] Once you’ve resolved their dendrite, what do you do? […] If it’s not resolving and you have a dendrite in a contact lens wearer, please think of Acanthamoeba keratitis. […] Dr. Carlson also recommends that physicians remain mindful of treatment costs. […] Looking toward the future of treatments, Dr. Tuli says the Holy Grail for simplex and maybe zoster wouldn’t be a treatment for the surface of the eye or the eye itself, but one that would shut the herpes virus replication down where it originates, in the trigeminal ganglion.

• #1 What You Should Know About Eye Herpes | Eye Vision Associates

  https://www.eyevisionassociates.com/what-you-should-know-about-eye-herpes-2021/

  Eye herpes, or HSV keratitis, is a common eye infection typically caused by type 1 herpes simplex virus (HSV-1), the same virus that causes cold sores around the mouth and lips. […] Herpetic eye infections can be confused with other types of pink eye, such as bacterial or other viral infections. Instead of self-treating an eye infection with antibiotics you have at home, get it examined by an eye doctor or physician, who can prescribe the right medication. Eye herpes won’t improve with antibiotics unless an antiviral is also used. […] Early diagnosis and treatment ideally within a 72 hour window can help mitigate severe eye damage and significantly improve your symptoms. […] Treatment typically includes antiviral medication, which can be eye drops, ointment, or oral medication. Your eye doctor will instruct you on how to manage your symptoms and prevent reinfection.

• #1 Eye Herpes: Symptoms, Treatment, Prognosis, and More

  https://www.verywellhealth.com/eye-herpes-5186846

  Eye herpes is usually diagnosed by eye specialists called ophthalmologists or optometrists. […] The eye specialist will take a health history and have a discussion of symptoms, including the items in the lists that follow. […] The eye-care specialist will also perform an eye exam that includes checking for light sensitivity, vision, and general health. […] Diagnostic tests and procedures the eye specialist may use include: Measurement of visual acuity: Tests how well you see shapes and details. […] External examination: Checks for things that can be seen on the outside of the eye, such as discharge, corneal sensation, and general appearance of the eyes, face, and eyelids. […] Slit-lamp biomicroscopy: Using a microscope that magnifies the surface and inside of the eye. […] Fluorescein eye stain test: A close examination of the cornea after dye is placed on the surface of the eye. […] Culture sample: Taking a culture swab (a small collection of cells) and sending it to a lab for further examination.

• #1 Ocular Herpes (Eye Herpes): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/ocular-eye-herpes

  Ocular herpes is when herpes viruses affect your eyes. Its a serious and often severe condition that can cause blindness, so it needs quick diagnosis and treatment. […] Your eye care specialist will look at the skin on your eyelid and around your eye, taking note of any blisters, color changes, etc. Theyll also ask questions about your medical history and recent events that could be relevant to your infection. […] If a healthcare provider hasnt previously diagnosed you with a herpes simplex or varicella zoster infection, there are several ways to test for these viruses. Those range from simple swabs of your eye surface to blood tests (either for current infection or antibodies from a past infection). […] An eye care specialist can also use other methods, including an eye exam, to determine the exact eye structures affected and how to treat the infection. One part of a standard eye exam, the slit lamp exam, lets your eye care specialist see inside your eye. That can help them determine the best way to treat this condition. […] Because so many different tests and methods can help in diagnosing and treating eye herpes, your eye care specialist is the best source of information about your specific case. They can tell you which tests they recommend and why.

• #1 Ocular Herpes Infection (Herpes Simplex Keratitis) – WordPress

  https://www.opdrmuratgul.com/en/ocular-herpes-infection-herpes-simplex-keratitis/

  Yes, herpes can affect the eyes, a condition known as ocular herpes or herpes simplex keratitis (HSK). […] The incidence of ocular herpes is approximately 150 cases per 100,000 people in developed countries. […] Patient history is essential. […] Clinical examination includes: Corneal sensitivity testing, Fluorescein and Rose Bengal staining. […] Laboratory tests: Papanicolaou stain for detecting Lipschtz bodies, Viral culture (gold standard if active virus is present), ELISA (detects viral antigens or immune response), Polymerase Chain Reaction (PCR) (detects viral DNA fragments).

• #1 Information about Herpes Eye Disease and Other Herpes Viruses Including Chickenpox

  https://www.webmd.com/genital-herpes/eye-herpes

  Your doctor might want to use special tests if it looks like herpetic eye disease might be present. The pressure inside the eye will probably be checked, for example. There is also a special dye called fluorescein that the doctor might put into the eye. This dye glows under ultraviolet light and will show the doctor if the virus is causing problems on the surface of the eye.

• #1 Herpes Simplex Keratitis | Wills Eye Hospital

  https://www.willseye.org/herpes-simplex-keratitis/

  Herpes simplex type 1 may present as an active infection in the cornea (dendritic keratitis or stromal keratitis), active inflammation (disciform keratitis), or both. […] Tests and Diagnosis: Slit lamp examination with special staining such as fluorescein dye is essential. Corneal viral cultures can be done, but are not commonly performed.

• #1 Herpes simplex eye infections | nidirect

  https://www.nidirect.gov.uk/conditions/herpes-simplex-eye-infections

  Herpes simplex eye infections are a common and potentially serious type of eye infection. […] It’s important to get medical help if you think you may have the infection. Your vision could be at risk if it’s not treated. […] Get medical help as soon as possible if you have the symptoms above. They could be caused by a herpes simplex infection or another eye condition that requires rapid treatment. If you have it, you will need to see an ophthalmologist (an eye specialist) for treatment. […] If it’s not treated quickly, there’s a chance your vision could be affected. […] Herpes simplex eye infections usually occur when a previous infection with the virus reactivates and spreads to the eye. […] Herpes simplex eye infections don’t usually cause further problems if they’re treated quickly. But about one in five cases are more serious and carry a higher risk of complications.

• #2 HSV Keratitis: An Important Infectious Cause of Blindness

  https://www.uspharmacist.com/article/hsv-keratitis-an-important-infectious-cause-of-blindness

  An estimated 500,000 people in the United States have herpes simplex virus (HSV) ocular disease. Each year about 50,000 new and recurring cases are diagnosed, with their treatment costing the nation approximately $17.7 million annually. Ocular HSV is considered the most common cause of infectious corneal blindness in the U.S. Many patients are often unsure as to whether or not to seek medical attention for an eye condition they experience as uncomfortable and distressing, but often consider unworthy of their doctors time and the expense of a consultation. Furthermore, ocular HSV is frequently misdiagnosed. In light of these issues, this article will address HSV keratitis and highlight the need to treat the condition and prevent recurrences, as well as the need for pharmacists to guide patients regarding these concerns. Symptoms of HSV keratitis include pain in and around the eye, redness, sensation of a foreign body in the eye, blurred vision, light sensitivity, and watery discharge. Characteristic signs include a dendritic corneal lesion (i.e., indicating dendritic keratitis) or disk-shaped, localized corneal edema and haze plus anterior uveitis (i.e., indicating endothelial, or disciform, keratitis). Diagnosis of HSV keratitis is confirmed by finding a dendritic ulcer via slit-lamp examination using fluorescein dye; if not conclusive, viral culture of the lesion can confirm the diagnosis.

• #2 Herpes Simplex Keratitis – Eye Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/eye-disorders/corneal-disorders/herpes-simplex-keratitis

  Herpes simplex keratitis is corneal infection with herpes simplex virus. […] Diagnosis is based on clinical suspicion, slit lamp exam findings, and sometimes viral culture. […] The diagnosis of herpes disciform keratitis and herpes stromal keratitis are predominantly clinical, based on a history of herpetic ocular disease and slit lamp exam findings. […] When the appearance is not conclusive, viral culture or a nucleic acid amplification tests (NAAT) swab of the lesion can confirm the diagnosis. […] Diagnosis is confirmed by characteristic clinical findings, by viral culture, or by NAAT swab.

• #2 Eye Herpes: Symptoms, Treatment, and More

  https://www.healthline.com/health/eye-herpes

  Eye herpes, or ocular herpes, is caused by the herpes simplex virus (HSV). Your treatment will depend on the severity of the infection and what part of the eye it affects. […] An experienced eye doctor can establish the correct diagnosis by collecting a thorough medical history and by performing a detailed eye examination. Careful slit lamp biomicroscopy with the use of a topical inert dye will unveil active herpetic lesions. […] A sterile cotton swab can be used to collect a sample for laboratory culture. If you have ocular herpes, the culture will test positive for type 1 HSV (HSV-1). Receiving a prompt, correct diagnosis can help you receive the appropriate treatment. […] To diagnose eye herpes, your doctor will ask you detailed questions about your symptoms, including when they started and whether you’ve experienced similar symptoms in the past.

• #2 Eye Herpes: Symptoms, Treatment, Prognosis, and More

  https://www.verywellhealth.com/eye-herpes-5186846

  Eye herpes is usually diagnosed by eye specialists called ophthalmologists or optometrists. […] The eye specialist will take a health history and have a discussion of symptoms, including the items in the lists that follow. […] The eye-care specialist will also perform an eye exam that includes checking for light sensitivity, vision, and general health. […] Diagnostic tests and procedures the eye specialist may use include: Measurement of visual acuity: Tests how well you see shapes and details. […] External examination: Checks for things that can be seen on the outside of the eye, such as discharge, corneal sensation, and general appearance of the eyes, face, and eyelids. […] Slit-lamp biomicroscopy: Using a microscope that magnifies the surface and inside of the eye. […] Fluorescein eye stain test: A close examination of the cornea after dye is placed on the surface of the eye. […] Culture sample: Taking a culture swab (a small collection of cells) and sending it to a lab for further examination.

• #2 Herpes Simplex Keratitis

  http://eyerounds.org/cases/160-HSV.htm

  HSV epithelial keratitis invariably involves active viral proliferation. The classic epithelial dendrite is the most common presentation of epithelial disease. It represents areas of epithelial breakdown due to cell destruction by proliferating virus and is best demonstrated after fluorescein staining under cobalt blue lighting. Adjacent epithelium stains with rose bengal in a „terminal bulb” configuration and represents intact, virally-infected epithelium. In immunocompetent individuals the herpetic epithelial disease is self-limited and will resolve, even in the absence of pharmacologic intervention. […] HSV stromal keratitis is associated with the highest and most severe morbidity of any ocular herpetic disease. Although this condition frequently follows previous HSV epithelial keratitis, it can be the initial presentation of ocular herpetic disease. The vast majority of cases are an immune stromal keratitis (ISK), which involves the antibody-complement cascade against retained viral antigens in the stroma.

• #2 Information about Herpes Eye Disease and Other Herpes Viruses Including Chickenpox

  https://www.webmd.com/genital-herpes/eye-herpes

  Your doctor might want to use special tests if it looks like herpetic eye disease might be present. The pressure inside the eye will probably be checked, for example. There is also a special dye called fluorescein that the doctor might put into the eye. This dye glows under ultraviolet light and will show the doctor if the virus is causing problems on the surface of the eye.

• #2 Diagnosis and Treatment of Herpes Keratitis

  https://www.reviewofophthalmology.com/article/diagnosis-and-treatment-of-herpes-keratitis

  With the help of antivirals and steroids, patients can find relief if the diagnosis is accurate. […] Herpes simplex keratitis and herpes zoster ophthalmicus each pose significant risk to a persons vision, making accurate diagnosis crucial to its treatment and ongoing prevention. […] Pain isn’t one of the primary complaints patients will have when it comes to herpes simplex keratitis. […] Knowing what to look for during the exam will help you determine the type of virus. […] Epithelial keratitis presents with linear dendrites with branches featuring distinct terminal bulbs. […] To confirm this diagnosis, fluorescein stain should be used for the center of the dendrites and rose bengal on the periphery. […] If any doubt exists, ordering a herpes PCR is a good idea. […] If the dendrites don’t have the classic presentation, several factors could cause that, including medication toxicity or a healing epithelial defect.

• #2 Be a Hero to Your HSVK Patients

  https://www.reviewofoptometry.com/article/ro0717-be-a-hero-to-your-hsvk-patients2

  HSVK is often diagnosed without the need for laboratory testing, so an understanding of the clinical signs and symptoms is critical. Proper diagnosis begins with a detailed history. Optometrists should elicit the exact clinical course of the patients symptoms. Some history items to probe include HSV recurrence, contact lens wear, medical and systemic history, nasal and oral cold sore history, recent topical or systemic steroid treatment and recent fever or ultraviolet light exposure. […] While laboratory testing is generally not needed to establish a diagnosis of HSVK, it can help to provide confirmation in the rare complicated case where the diagnosis is in doubt. The standard in diagnosis of HSVK is viral isolation in a culture. […] Additional tests that can be conducted include Giemsa stains of the cornea and skin scrapings, enzyme-linked immunosorbent assay testing, HSV antibody titers and polymerase chain reaction assays. […] The wide variety of conditions that can masquerade as HSVK makes the history and work-up vital to a correct diagnosis. In any case of epithelial, stromal or endothelial keratitis, if the patients story does not fit the clinical findings, then HSVK should be at the top of your differentials.

• #2 Herpes Simplex Keratitis

  http://eyerounds.org/cases/160-HSV.htm

  Herpes simplex keratitis is the most common corneal infection in the United States. It is the number one cause of corneal and infectious blindness and a leading indication for corneal transplantation. The diagnosis of HSV keratitis is primarily clinical, although additional tests may be useful in providing confirmation, but never exclusion. The Tzanck (Giemsa) smear of multinucleated epithelial cells is a quick test with high specificity but low sensitivity. Viral culture remains the gold standard with high sensitivity for detection of the virus. Other tests include a viral antigen assay and polymerase chain reaction (PCR), which has the highest specificity. It should be noted that these tests are only positive when live virus is present as seen in HSV epithelial keratitis and cannot be used to diagnose, or exclude, active disease caused by immunologic reactions against HSV triggered by prior infections, which is typically the case for HSV stromal keratitis.

• #2 Effective diagnosis by real-time PCR of herpes simplex diffuse endotheliitis that is similar in appearance to fungal keratitis: case series | Journal of Ophthalmic Inflammation and Infection | Full Text

  https://joii-journal.springeropen.com/articles/10.1186/s12348-021-00250-6

  Herpes simplex diffuse endotheliitis with accompanying feathery infiltration is difficult to diagnose due to corneal findings that are similar to fungal keratitis. This case series reports on the effectiveness of using real-time polymerase chain reaction (PCR) to diagnose herpes simplex diffuse endotheliitis that is similar in appearance to fungal keratitis. […] Real-time PCR was an effective tool in diagnosing HSV diffuse endotheliitis with feathery infiltration. […] The diagnosis of HSV endotheliitis with accompanying feathery infiltration is difficult, as the clinical findings for this are highly similar to that observed for fungal keratitis. Based on our current findings, we propose that real-time PCR of corneal scraping samples are an essential diagnostic tool in the elucidation of this disease. […] In conclusion, this report described 3 cases of HSV diffuse endotheliitis, which is a rare form of HSK. All 3 cases were successfully diagnosed through the use of real-time PCR in combination with direct microscopy.

• #2 Herpes Simplex Virus (HSV) Keratitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1194268-overview

  Herpes simplex keratitis remains primarily a clinical diagnosis based on characteristic features of the corneal lesion. […] If the diagnosis is in doubt, however, laboratory diagnosis can be made using the following: Giemsa stain – Scrapings of the corneal or skin lesions show multinucleated giant cells. […] Papanicolaou stain – This shows intranuclear eosinophilic inclusion bodies. […] Viral culture. […] Immunohistochemistry looking for herpes simplex viral antigens. […] Polymerase chain reaction (PCR) assay.

• #2 Testing for Herpes Simplex

  https://www.reviewofoptometry.com/article/testing-for-herpes-simplex

  There are lab or in-office tests available to help solidify the diagnosis in the event of an unclear presentation. „The enzyme-linked viral inducible system (ELVIS) creates fluorescent antibodies that are absorbed by the viral particles. We then see a positive staining reaction,” says Dr. Perry. ELVIS results are available in as little as 24 hours. […] Other tests include complement fixation, where the patient is examined for antibodies for herpes simplex, Dr. Perry says. „We can find out if the titer is rising or falling, because a certain level will indicate an active infection. Or, consider MicroTrak (Trinity Biotech), a direct fluorescent antibodies test, or HerpChek (DuPont), an enzyme immunoassay.” […] „The gold standard is the polymerase chain reaction (PCR), which seems to be very effective,” adds Dr. Perry. „Or, the practitioner can order an actual culture of the viral particles in monkey kidney cells–the timeline for that is about a week, and that’s more expensive.”

• #2 Diagnosis and Treatment of Herpes Keratitis

  https://www.reviewofophthalmology.com/article/diagnosis-and-treatment-of-herpes-keratitis

  Diagnosis may be further challenged if the patient has other forms of ocular surface disease. […] Once the correct virus has been identified, treatments include oral and topical antivirals, and steroids. […] The treatment for epithelial disease is primarily antivirals. […] If it’s zoster, then there’s been some evidence that ganciclovir might work topically. […] Not to mention, if it’s stromal disease, topical medications don’t work. […] The efficacy of using antivirals prophylactically in HZO is the aim of the Zoster Eye Disease Study. […] Once you’ve resolved their dendrite, what do you do? […] If it’s not resolving and you have a dendrite in a contact lens wearer, please think of Acanthamoeba keratitis. […] Dr. Carlson also recommends that physicians remain mindful of treatment costs. […] Looking toward the future of treatments, Dr. Tuli says the Holy Grail for simplex and maybe zoster wouldn’t be a treatment for the surface of the eye or the eye itself, but one that would shut the herpes virus replication down where it originates, in the trigeminal ganglion.

• #2 Herpes Simplex (Eye Infection): Symptoms and Treatment

  https://patient.info/eye-care/eye-infection-herpes-simplex

  Herpes simplex is a virus that causes cold sores and genital herpes. However, it can also cause eye infections. […] If you have had cold sores and then get an achy, red, sore eye it is important to see a doctor as soon as possible. […] How is herpes simplex eye infection diagnosed? […] Your family doctor (GP) will usually examine your eye with a magnifier. They may also put some stain on the front of your eye. This is used to show up any irregular areas on the transparent front part of the eye. With a herpes simplex infection they will often see a small scratch on the cornea. The typical ulcer which develops is called a dendritic ulcer. […] If your doctor suspects a herpes eye infection you will usually be referred urgently to an eye specialist (ophthalmologist). A specialist will do a detailed magnified examination of the eye. This is to confirm the diagnosis and to determine whether the infection is in the top layer of the cornea (epithelial keratitis), or if the deeper layers are involved (stromal keratitis).

• #2 Ocular Herpes Infection (Herpes Simplex Keratitis) – WordPress

  https://www.opdrmuratgul.com/en/ocular-herpes-infection-herpes-simplex-keratitis/

  Yes, herpes can affect the eyes, a condition known as ocular herpes or herpes simplex keratitis (HSK). […] The incidence of ocular herpes is approximately 150 cases per 100,000 people in developed countries. […] Patient history is essential. […] Clinical examination includes: Corneal sensitivity testing, Fluorescein and Rose Bengal staining. […] Laboratory tests: Papanicolaou stain for detecting Lipschtz bodies, Viral culture (gold standard if active virus is present), ELISA (detects viral antigens or immune response), Polymerase Chain Reaction (PCR) (detects viral DNA fragments).

• #2 Signs of Ocular Herpes and Treatment Options – NVISION

  https://www.nvisioncenters.com/conditions/ocular-herpes/

  Ocular herpes is sometimes difficult to diagnose. The condition is incurable, although is treatable. Once a person is infected, the virus will periodically reactivate, either randomly or through triggers. […] If your doctor has been unable to diagnose your condition, or diagnosed you and your prescribed treatment is not working as it should, consider seeing a specialist to check if you were misdiagnosed or if there are other treatments available. […] Your doctor can make the correct diagnosis by conducting a culture test. If you have ocular herpes, the culture will test positive for type 1 or type 2 HSV. […] Fortunately, both mild and severe ocular HSV infections can be treated with antiviral medication. But its imperative to correctly diagnose the condition and treat it early to prevent severe damage to the cornea.

• #2 Herpes simplex eye infections | nidirect

  https://www.nidirect.gov.uk/conditions/herpes-simplex-eye-infections

  Herpes simplex eye infections are a common and potentially serious type of eye infection. […] It’s important to get medical help if you think you may have the infection. Your vision could be at risk if it’s not treated. […] Get medical help as soon as possible if you have the symptoms above. They could be caused by a herpes simplex infection or another eye condition that requires rapid treatment. If you have it, you will need to see an ophthalmologist (an eye specialist) for treatment. […] If it’s not treated quickly, there’s a chance your vision could be affected. […] Herpes simplex eye infections usually occur when a previous infection with the virus reactivates and spreads to the eye. […] Herpes simplex eye infections don’t usually cause further problems if they’re treated quickly. But about one in five cases are more serious and carry a higher risk of complications.

• #2 Herpes Simplex Eye Infections: Symptoms and Treatment

  https://patient.info/doctor/herpes-simplex-eye-infections

  Herpes simplex eye infections can be diagnosed through clinical examination and may not require further investigation following ophthalmological review. […] If there is doubt over the diagnosis, corneal or skin scrapings can be taken and a viral swab may be performed. […] Polymerase chain reaction (PCR) can identify minute quantities of herpes simplex viral DNA in tissue samples and tears. […] Real-time PCR may be a useful technique for rapid diagnosis of ocular HSV infection, particularly in the identification of aciclovir-resistant keratitis. […] Specialist diagnosis of ocular herpes simplex may be made by slit-lamp examination which may show corneal vesicles. […] Corneal or skin scrapings, or a viral swab, can be analysed by viral culture and/or polymerase chain reaction (PCR), to detect herpes simplex virus (HSV) DNA.

• #2 Herpes Simplex Ophthalmicus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559194/

  Herpes simplex ophthalmicus is an eye infection by the herpes simplex type 1 and type 2 viruses. […] Early diagnosis and treatment are keys to preventing complications. […] Most diagnoses are done clinically or with the slit lamp examination because of the distinct characteristics of the infection. Laboratory diagnosis is done in atypical cases where the clinical picture doesn’t yield a conclusive diagnosis because of drug toxicity, immunosuppression, and polytherapy. The following are the methods to confirm Herpes simplex infection. […] Polymerase chain reaction (PCR) DNA Testing: Polymerase chain reaction test is the preferred test for ocular HSV infection to detect HSV DNA. It is more sensitive than virus culture in the diagnosis of epithelial keratitis. […] Antiviral medication is the mainstay of treatment for the herpetic epithelial disease.

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