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Lecture 21
Ocular Pharm.
10
Medical
Professional
11/11/2008

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Term
Herpes Simplex Epithelial Keratitis
Definition
HSV-1; Oral Infection: Epithelial a. Replicates in corneal epithelium only b. Dendnrite as a result of epithelial cell destruction; Stromal – viral antigens diffuse into strom stimulating Ag-Ab rx causing stromal edema and permeability that leads to opacification and necrosis in severe cases; Netrotrophic Ulcer a. Structural damage to the basement membrane causing sterile ulcer, b. Persist even with therapy that may lead to corneal melting and perforation .
Term
Herpes Simplex Epithelial Keratitis Signs
Definition
Earliest lesions are small clear raised vesicles in the epithelium; Within 24 hrs. lesions coalesce to form the dendritic and geographical ulcers, Initially true dendrites might only stain with NaFL in the middle; Swollen Border (raised) w/ live virus stain w/ Rose Bengal; Healing dendrite can leave a typical “footprint” scar (subepithelial)
Term
Treatment for Herpes Simplex Epithelial Keratitis
Definition
1. Trifluridinen (DOC) 2. Idoxuridine (IDU), Vidarabine
Term
Trifluridine
Definition
ttmt. for Herpes Simplex Epithelial Keratitis, Analog of thymidien, Phosphorylated by viral and host thymidine kinase, Mode of action: a. Inhibition thymidine synthase in viral and host cells, b. Incorporates into viral DNA chain; 1 % ophthalmic solution (viroptic); Drug of Choice; Side effects: Epithelial defects, Recurrent corneal erosion, Transient burning sensation (chemosis and hyperemia)
Term
Idoxuridine
Definition
ttmt. for Herpes Simplex Epithelial Keratitis; Nitrogenous compound similar to thymidine; Phosphorylated by host cell and viral thymidine kinase, Excessive toxicity if used systemically, 0.1% ophthalmic solution and 0.5% ophthalmic ointment; Side effects: Superficial Punctate Keratitis (SPK), Corneal Ulceration, Stromal Opacification – Cytoxocity,
Term
Vidarabine
Definition
ttmt. for Herpes Simples Epithelial Keratitis; Analog of adensine, Phosphorylated by viral andn host’s cell kinase, Mode of action: Inhibits DNA polymerase, Predilection for viral polymerase 3% ophthalmic ointment; Primarily used in stage 1 herpes keratitis; Adjunct treatment in zoster ophtalmicus; Side effects similar to idoxuridine but less toxic
Term
Herpes Zoster Ophthalmicus
Definition
Reactivation of Varicella virus (chickenpox in childhood);Peak age 50-70 year old; In young patients: r/o HIV; Affects 1st. dive CNV: Fronntal ( upper lid, sup. conjuncitva, forehead); if Nasociliary (globe) (Hutchinsonn sign) so more prob. of ocular inv. (corneal
Term
Herpes Zoster Opthalmicus Signes
Definition
Erythematous vesicles respecting midlen, which after a few days crust; Follicular reaction, lympadenopathy; Associated ocular – small pseudodendrites or non-specific SPK
Term
Treatment for Herpes Zoster Ophthalmicus
Definition
Adult w/ acute mod-severe rash and onset of 72 hours or less, Palliative for lesions – warm compress; Antibiotic topical ung for 2ry infection; Corneal pseudodendrites or SPK; artificial tears q 1-2h and ung (refresh plus, Refresh PM); Acyclovir
Term
Acyclovir
Definition
Treatment for Herpes Zoster Ophthalmicus; Analogue of guanosine; Phosphorylated by viral thymidine kinase only; Mode of action – inhibits viral DNA polyermase; 200
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