Type Grand roundsDate 24/10/2019Presenter Dr. K SivaniModerator Dr. J Raghava

Clinical summary

• A 9 year boy was brought by father with complaints of pain, blurring of vision, redness, watering both eyes since 10 days.

• In Right Eye- large epithelial defect with diffuse cellularity and hypopyon• In Left Eye- epithelial defect with stromal infiltration

Right eye

Left eye

Provisional Diagnosis of both eyes Herpes simplex viral necrotizing stromal keratitis was made

Antivirals(oral and topical) and topical steroids were given

Post treatmentRight eye

Left eye

Objectives of the presentation:

Differential diagnosis of HSV necrotizing stromal keratitis Clinical presentation of HSV keratitis Management of HSV necrotizing stromal keratitis

References :

1. Herpes simplex viral keratitis: A treatment guideline-2014, Michelle Lee White, MD, MPH and James Chodosh, MD, MPH. Reviewed and endorsed by the Ocular Microbiology and Immunology Group

2. Diagnosis of herpes simplex virus 1 keratitis: Comparision of giemsa stain, immunofluorescence assay and polymerasechain reaction, shaheen subhan, roby james jose et al.,2004, vol.29, Nos.2-3,pp. 209-213

3. Management of acute ulcerative and necrotizing herpes simplex and zoster keratitis with amniotic membrane transplantation., A. Heiligenhaus,, h li et al., Br J Ophthalmol 2003; 87;1215-1219