5.14 Keratitis, Viral, Herpes Simplex

eyes.nhs.scot/
Eyecare Guidelines/
Section 5 - Cornea/
5.14 Keratitis, Viral, Herpes Simplex

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

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