Introduction
Though globally, an estimated 4.0 billion people are infected
with the herpes virus, however even after several years of
intensive research into herpes simplex virus keratitis (HSK)
and substantial progress in understanding its virology, the
management of this condition continues to be challenging.1 In
addition, in an under developed country like ours where
bacterial and fungal keratitis are far more common, a viral
etiology for keratitis is generally not thought of initially, which
along with topical mydriatics i.e. eye drop homatropine 0.5%
QID. Within 48 h of treatment the patient claimed a symptomatic
relief, with his pain reducing and his vision improving
to 6/36. However 5 days later the patient complained of an
increase in pain. His vision was reduced to 4/60 and the IOP
had increased to 54 mm of Hg NCT. Slit lamp examination
revealed a hazy edematous cornea, cells in the anterior
chamber as well as keratic precipitates on the corneal endothelium
(Fig. 3). A diagnosis of anterior uveitis in association
with the stromal keratitis and endothelitis was made.
Systemic as well as topical antiglaucoma drugs i.e. tab acetazolamide
250 mg QID as well as eye drop timolol 0.5% BD and
eye drop dorzolamide 2% TDS was added to his treatment .In
addition topical steroids i.e. eye drop prednisolone acetate 1%
QID was also added. The IOP decreased to below 20 mm of Hg
NCT within 3 days and the tablet acetazolamide was stopped,
however the topical antiglaucoma medication was continued
for another 2 weeks. The patient too symptomatically
improved with his vision improving to 6/24 and pain totally
disappearing. The oral and topical acyclovir was continued for
2 more weeks. The topical prednisolone was continued for
a month in tapering dosage and replaced by a milder steroid
IntroductionThough globally, an estimated 4.0 billion people are infectedwith the herpes virus, however even after several years ofintensive research into herpes simplex virus keratitis (HSK)and substantial progress in understanding its virology, themanagement of this condition continues to be challenging.1 Inaddition, in an under developed country like ours wherebacterial and fungal keratitis are far more common, a viraletiology for keratitis is generally not thought of initially, whichalong with topical mydriatics i.e. eye drop homatropine 0.5%QID. Within 48 h of treatment the patient claimed a symptomaticrelief, with his pain reducing and his vision improvingto 6/36. However 5 days later the patient complained of anincrease in pain. His vision was reduced to 4/60 and the IOPhad increased to 54 mm of Hg NCT. Slit lamp examinationrevealed a hazy edematous cornea, cells in the anteriorchamber as well as keratic precipitates on the corneal endothelium(Fig. 3). A diagnosis of anterior uveitis in associationwith the stromal keratitis and endothelitis was made.Systemic as well as topical antiglaucoma drugs i.e. tab acetazolamide250 mg QID as well as eye drop timolol 0.5% BD andeye drop dorzolamide 2% TDS was added to his treatment .Inaddition topical steroids i.e. eye drop prednisolone acetate 1%QID was also added. The IOP decreased to below 20 mm of HgNCT within 3 days and the tablet acetazolamide was stopped,however the topical antiglaucoma medication was continuedfor another 2 weeks. The patient too symptomaticallyimproved with his vision improving to 6/24 and pain totallydisappearing. The oral and topical acyclovir was continued for2 more weeks. The topical prednisolone was continued fora month in tapering dosage and replaced by a milder steroid
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