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Abstract: This male patient, 48 years old, had redness, pain, photophobia, tearing and other uncomfortable symptoms in the lower eyelid of the right eye 2 days ago, went to the pharmacy to buy ofloxacin eye drops on his own, but the symptoms did not improve significantly, so he went to our hospital and was diagnosed with herpes simplex virus keratitis and blepharitis in the right eye after examination, and was instructed to pay attention to rest and not to stay up late, and was given standardized medication for 2 weeks and then reviewed, and his condition was significantly relieved.
Basic information】Male, 48 years old
Disease Type】Herpes simplex virus keratitis
Hospital】Jiangxi Provincial People’s Hospital
Date of consultation】January 2022
Treatment plan】Topical medications (acyclovir cream, acyclovir eye drops, ganciclovir eye gel, calf blood deprotein extract eye gel)
Treatment Period】Outpatient treatment for 2 weeks, outpatient follow up
Effectiveness】The eye discomfort disappeared, the inflammation of the cornea subsided, the epithelium basically healed, and the skin of the eyelid became lightly pigmented.
I. Initial consultation
The patient, a 48-year-old male, had redness and translucent blisters on the lower eyelid of his right eye two days ago, with no obvious pain in the skin, and discomfort symptoms such as redness of the white eye, pain, photophobia and tearing. Visual acuity: right eye 4.7, left eye 5.0. IOP: right eye 15 mmHg, left eye 14 mmHg. right eyelid swollen, redness and dense herpes on the lower lid skin, no skin damage on the forehead and scalp, no obvious skin tenderness, lid fissure smaller, conjunctival congestion obvious, corneal hyperaesthesia, dendritic staining of corneal epithelium, anterior chamber flash positive, round pupil, light reflex sensitive, left eyelid and No abnormalities were seen in the left eyelid and eyeball. Outpatient diagnosis: herpes simplex virus keratitis and blepharitis in the right eye.
II. Treatment history
After the diagnosis was confirmed, the patient was advised to take rest, not to stay up late, and to pay attention to the skin hygiene of the upper lid of the right eye, and was given topical acyclovir cream, as well as topical acyclovir drops and ganciclovir ophthalmic gel for the right eye for 2 weeks and was reviewed regularly. Except for a slight foreign body sensation, the patient’s right eye redness, pain and photophobia and tearing symptoms improved significantly. The patient was instructed to stop using the above drugs and apply topical ophthalmic gel with calf blood deprotein extract alone to reduce drug toxicity and promote corneal epithelial repair.
III. Treatment effect
The patient reported that the redness, pain and photophobia of the right eye were significantly improved, except for a slight foreign body sensation. Visual acuity: right eye 5.0, left eye 5.0. IOP: right eye 15 mmHg, left eye 16 mmHg. pigmentation of the lower lid skin of the right eye, mild conjunctival congestion of the right eye, corneal transparency, a little dot staining below the cornea, negative anterior chamber flash, and no other abnormalities were seen. The patient felt very satisfied with the recovery of vision and the obvious relief of ocular discomfort.
IV. Notes
I am glad that after active treatment, the patient’s symptoms were relieved. In daily life, we should pay attention to good eye cleaning and hygiene, and maintain a healthy diet and normal living habits. The patient had a milder condition and quicker recovery because herpes simplex virus invaded the eyelid skin and corneal epithelium but did not invade the deeper layers of the cornea due to decreased resistance.
The patient was also instructed to seek medical advice whenever he felt an increase in ocular discomfort, such as decreased vision and increased secretions, to avoid aggravation of the disease and difficulty in recovery, which could lead to adverse consequences.
V. Personal insight
Herpes simplex virus keratitis is an infectious keratopathy caused by herpes simplex virus, which has a long course and is prone to recurrence after healing, often leading to superficial and deep inflammation and ulceration of the cornea, which can be accompanied by iridocyclitis, pus accumulation in the anterior chamber or secondary glaucoma, and is one of the more common blindness-causing eye diseases in clinical practice.
For patients with this disease, in addition to giving the appropriate treatment plan, patients should be advised to pay attention to good eye hygiene, and maintain a healthy diet and normal living habits, do not stay up late, after the medication should be regularly reviewed, according to the condition of the type and frequency of medication adjustment. Do not abuse glucocorticoid eye drops to avoid recurrence and aggravation of the disease, and be cautious and reduce the dosage of oral acyclovir tablets to avoid side effects of the drug on the liver and kidneys.