A 18 yrs/m , with lesion in eye since last 5 days . Slight ciliary congestion on presentation was present . Can is 6/36. He gave h/o chickenpox 15 days back. Dx & Rx .

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This pt had disciform keratitis with small epithelial bullae , a ring of confluent deposits on endothelium beneath the area of disciform keratitis , kps in lower part & an isolated area of superficial stromal keratitis in the 7 o'clcok position between disciform area & limbus. Rx given : Tab. Acyclovir 400mg 5 times/day. Tab. Paracetamol . Tab . Dexamethasone . Antibiotics with steroid eye drops 1 & half hourly. Atropine e/drops tid. Timolol e/drops bid. Bullae disappeared as seen on 1st f/up checkup after 24 hrs . Corneal edema & kps also began regressing . The Rx will need to be continued for more than 1 month to expect significant reduction in disciform keratitis. There is conspicuous increase in eye complications in chickenpox recently. In last 7 to 8 months , i saw 3 cases developing iridocyclitis & 1 case developing disciform & stromal keratitis following chickenpox.

Three important things r to be noted in this case- eye problem following varicella, cloudy carnea And impaired vision. Dendritic epethelial keraritis is reported following varicella- zoster infection. Flores ent staining, for dendritic lesions and tear PCR for viral DNA r recommended . The complication is more in immunosuppressed and hence HIV status may be important. Acyclovir topical may ne helpful. This is not authentic unless uthenticated by optholmologists on evidence based medicine?

Viral keratitis with conjunctivitis ,small corneal haziness at 7 o'clock position,due herpes zoster virus treat with antiviral,local antibiotic drops, if corneal abrasion /ulcer then atropine oint with sterile dressing , orally Chloromycetin prophylactic,antiinflamatory

Steroid eye drops r must in this condition along with the regime u mentioned.Timolol e/drops should also be prescribed.

Disciform keratitis —- predfort eye drops , acyclovir tad 400mg 5 times for 10 days

Could be herpes zoster disciform keratitis.

Stromal keratitis

Patient might having stromal keratitis or might be anterior uveitis

Kindly go for ophthalmology opinion first

Dr Harshad himself is opthalmologist sir.

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Stromal haze luk fr whether epithelium on r not.depending on stain negativity go fr topical high dose steroids

Dr Harshad Gajjar,steroid eye may increase viral infection I think so, please reply

This disciform keratitis is an immunological response to herpetic antigens present In the cornea . No active infection is present at all in this condition . More over acyclovir is prescribed to prevent exacerbation of infection . Without steroid there would not be improvement & great corneal damage would result.
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