Test 29  (Herpetic eye disease)

1. The following are true about herpes simplex:

a. herpes keratitis in infants is caused mainly by type II 
    herpes simplex

b. ocular disease is the most common manifestation of 
    primary type I herpes simplex

c. herpes simplex can be contracted from pests

d. ocular recurrence is usually caused by virus 
    reactivation within the trigeminal ganglia

e. ocular recurrence is more common than either genital 
    or oral recurrence
 

Answer
a.T   b.F   c.F   d.T   e.F
Type II herpes simplex is associated with genital herpes. Infants passing through the infected birth canal can acquire ocular disease. Oral disease is commoner than ocular disease in primary type I herpes simplex.
Human is the only natural reservoir of herpes simplex.
Genital and oral recurrence are commoner than ocular recurrence in herpes simplex disease.

2. With regard to herpes epithelial ulcer:

a. the sensation is reduced

b. the disease usually presents initially as punctate keratitis

c. geographical ulcer occurs as a result of inappropriate 
    use of topical steroid

d. the ulcer has typical tapering endings

e. Rose Bengal stains infected epithelial cells
 

Answer
a.T   b.T   c.T  d.F  e.TThe ulcer has bead-like endings.

3. The following are true about acyclovir

a. topical acyclovir is more effective than oral acyclovir in 
    the treatment of herpes simplex epithelial keratitis

b. valacyclovir is the prodrug of acyclovir

c. the dosing frequency is less with valacyclovir than 
    acyclovir

d. oral acyclovir reduces the incidence and severity of 
    postherpetic neuralgia

e. oral acyclovir given daily can reduce the recurrent of 
    herpes simplex epithelial keratitis
 

Answera.F  b.T  c.T  d.F  e.T
Both topical and systemic acyclovir are equally effective in the treatment of herpes simplex epithelial keratitis. 
Oral acyclovir reduces the ocular complications of herpes zoster ophthalmicus but does not reduce the incidence and severity of postherpetic neuralgia. 

4. In the treatment of herpes simplex ocular disease :

a. oral acyclovir has no effect on the development of 
    stromal keratitis in the subsequent year when given 
    during active herpes simplex keratitis

b. oral acyclovir reduces the development of iritis in the 
    subsequent year when given during active herpes 
    simplex keratitis

c. in patients with previous herpes simplex stromal 
    keratitis, oral acyclovir reduces the likelihood of 
    recurrent stromal disease

d. stopping oral acyclovir in a patient with previous 
    herpes simplex stromal keratitis causes rebound of 
    herpes simplex disease

e. oral acyclovir has no effect on herpes simplex iritis

Answer
a.T   b.F  c.T  d.F  e.F
According to HEDS (Herpetic Eye Disease Studies), oral acyclovir has no effect on the development of 
stromal keratitis or iritis in the subsequent year when given during active herpes simplex keratitis. However, 
oral acyclovir can reduce the likelihood of recurrent 
stromal disease in patients with previous herpes simplex stromal keratitis. Cessation of oral acyclovir does not cause rebound of herpes simplex disease. Oral acyclovir is useful in the treatment of herpes simplex iritis.

 

5. In the treatment of herpes simplex stromal disease, HEDS (Herpetic
    Eye Disease Studies) show that:

          a. topical steroid reduces the duration of the disease

b. patients on topical steroid has better visual outcome at 
    six months review than the non-steroid treated group

c. topical steroid increases the likelihood of epithelial 
    disease

d. systemic steroid is useful in the management of 
    necrotizing stromal keratitis

e. oral acyclovir has added benefit in patients treated with 
    topical steroid and trifluridine
 

Answer
a.T   b.F  c.F  d.F  e.F
HEDS shows that topical steroid reduces the severity and the duration of herpes simplex stromal disease. 
However, there is no significant visual outcome between those treated with steroid and those with placebo. 
There is no increase in epithelial disease during topical 
steroid treatment. The study did not look into necrotizingstromal keratitis. Oral acyclovir does not appear to have added benefit in those patients treated with topical steroid and trifluridine. 

 

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