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What is the cause and treatment for herpetic keratitis?

Q: My brother is suffering from blurred vision in the left eye for the past 10 days. He can't even read the first line of Snellen's chart with the left eye. There is no significant redness but mild irritation at the onset. He was prescribed Tobramycin drops with a diagnosis of conjunctivitis. He consulted another doctor, who said it was a corneal disease and referred him to another doctor. The third doctor diagnosed it as herpetic keratitis. He prescribed Acyclovir orally thrice a day and topical steroid drops 4 times daily. He asked if there was any irritation or burning sensation and said that he might need treatment for a month and tapered doses for longer time. He had chickenpox at 12 years of age. His grandfather had herpes zoster involving neck area when he 10 years old. He has no history of coming in contact with chicken pox or herpes cases recently. There is a 2-3 mm area of haziness (grey white) over the left cornea inner quadrant. Is the dose of Acyclovir 400 mg thrice daily sufficient? Will topical steroids aggravate the condition? Can this be cured permanently? Does he need to remain in isolation? Can he have sexual intercourse? If his wife gets pregnant, will it affect his child?

A:This seems either herpetic keratitis or fungal infection. If it is herpetic keratitis, it needs Acyclovir ointment in this eye 3hrly and no tablet and definitely no steroid drops in any case. Diagnosis has to be confirmed by scrapings and microbiological investigations. Fungal infection is more resistant to treatment and requires anti fungal treatment. Steroids will aggravate the condition. It will get permanently cured but vision will remain blurred due scar in the cornea and may require corneal transplant later to get rid of corneal scar and improve vision. You don't need isolation but keep your towels and toiletries separate to prevent infection in the other eye or to another person. Herpetic keratitis usually remains confined to one eye only. There is no harm in intercourse but hygiene care has to be exercised to prevent spread of infection. If the wife gets pregnant, it will not affect the child.

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