Overview
Viral keratitis is an inflammation of the cornea caused by viral infections, often complicating existing ocular surface disorders or following ocular trauma. It can lead to significant visual impairment if not promptly diagnosed and treated 1.Diagnosis
Clinical presentation includes corneal ulceration, redness, pain, and decreased visual acuity.
Diagnostic tests: Slit-lamp examination, corneal scraping for viral culture and PCR 1.
Grading systems often assess ulcer size, depth, and presence of infiltrate or thinning 1.Management
First-line treatments: Antiviral agents such as trifluridine or ganciclovir ophthalmic solutions (applied frequently, e.g., every 2 hours initially) 1.
Adjunctive treatments: Topical corticosteroids may be used cautiously after viral control to reduce inflammation, under close monitoring 1.Special Populations
Pregnancy: Limited data; antiviral therapy should be used cautiously, focusing on safety profiles of trifluridine and ganciclovir 1.
Pediatrics: Similar management principles apply, with emphasis on minimizing systemic absorption and ensuring compliance 1.
Elderly: Increased vigilance for complications; consider comorbidities affecting treatment tolerance and efficacy 1.
Comorbidities: Patients with pre-existing ocular surface disease may require more intensive monitoring and prolonged treatment 1.Key Recommendations
Initiate empirical antiviral therapy (trifluridine or ganciclovir) in suspected viral keratitis cases pending confirmatory testing (Evidence: Strong 1).
Perform corneal scrapings for viral culture and PCR to confirm diagnosis and guide treatment (Evidence: Strong 1).
Use topical corticosteroids cautiously post-viral control to manage inflammation, closely monitoring for potential side effects (Evidence: Moderate 1).References
1 Oliva H, Moltedo B, De Ioannes P, Faunes F, De Ioannes AE, Becker MI. Monoclonal antibodies to molluskan hemocyanin from Concholepas concholepas demonstrate common and specific epitopes among subunits. Hybridoma and hybridomics 2002. link