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Herpetic Interstitial Keratitis with Chlamydia Seropositivity Kelly Boucher, O.D Abstract This case of herpes simplex interstitial keratitis with an underlying chlamydial component will emphasize the importance of accurate assessment and speedy intervention in the prevention of corneal blindness due to chronic or recurrent interstitial keratitis. I. Case History Chief Complaint: 19yo American Indian female presents for a swollen right eye progressively getting worse, with history of similar “flare ups” in past year (+) photophobia (+) pain (+) mattering Medical Hx: Allergic rhinitis, asthma Current Medications: Fluticasone, Levonorgestrel/Ethinyl Estradiol II. Pertinent findings Visual Acuity sc OD: 20/100 PH 20/50 OS: 20/30 PH 20/25 Pupils, CVF, and EOMS were normal Biomicroscopy OD: Adnexa: clear Lids/Lashes: blepharitis, ptosis, tenderness, erythema and edema of superior lid Conjunctiva: 360 injection Cornea: Superior haze with neovascularization to pupil margin. Scattered stromal infiltrates greatest superiorly. Small lisamine green staining over infiltrates. (-) rose bengal edge staining. (Photodocumented corneal findings) AC: Deep and Quiet Lens: Clear Biomicroscopy OS unremarkable except for: Cornea: Minimal superior neovascularization and a few small inferior scars Intraocular Pressures: OD: 13 mmHg OS: 15mmHg Fundus Evaluation: not performed Laboratory studies: CBC – no abnormalities RPR – non-reactive Chlamydia panel – reactive for IgG, IgA, and IgM Corneal culture – moderate coagulase negative staphylococcus Previous lab results of HSV-1 IgG positive and HSV-2 IgG negative III. Differential diagnosis Herpes Simplex Keratitis Adult Inclusion Conjunctivitis Syphilis Bacterial Keratitis IV. Diagnosis and discussion Ocular presentations of herpes simplex including: Dendritic Keratitis Blepharoconjunctivits Interstitial Keratitis Disciform Keratitis Recurrence of herpes simplex Presentation and chronicity of adult inclusion conjunctivitis Laboratory orders and interpretation of results V. Treatment, management Initial treatment with oral antivirals, topical antivirals in combination with topical steroids, as well as oral Azithromycin Long term management with prolonged topical steroid tapering and maintenance dosing of oral antivirals according to the Herpetic Eye Disease Study VI. Conclusion Clinical pearls of acute red eyes History Associated factors Clinical appearance Additional lab testing Bibliography/Resources Photos will be included
