Date of last review: Due to be updated

Differential diagnosis

  • Herpes zoster keratitis
  • Bacterial keratitis
  • Fungal keratitis
  • Acanthamoeba keratitis
    • In a contact lens wearer, always consider acanthamoeba keratitis
  • Healing corneal epithelial defect

Possible management by Optometrist

Treatment

  • PoM in non-contact lens wearing adults and where HSK is confined to the epithelium (dendritic), commence antiviral therapy with one of the following:
    • Aciclovir 3% ointment 5x daily for one week
    • Or Ganciclovir 0.15% ophthalmic gel 5x daily for one week
  • Instruct the patient to return in one week
    • If the dendritic ulcer has not healed
      • Instruct the patient to continue using the treatment five times a day and phone the Ophthalmology department to arrange an appointment (or follow local HB protocols where in place) 
    • If the dendritic ulcer has healed
      • Instruct the patient to reduce the treatment to three times a day for another seven days and then STOP (or follow local HB protocols where in place)

Advice

  • Discharge patient with offer to review, if symptoms recur

Management Category

  • Refer urgently (within one week) to ophthalmologist if
    • Epithelium has not healed after seven days
  • Emergency (same day) referral if
    • Stroma involved
    • Anterior uveitis
    • Raised intraocular pressure
    • Children
    • Contact lens wearer
    • Bilateral cases

Possible management by Ophthalmologist

  • Topical and/or systemic Antivirals
  • Topical steroid if epithelium intact