|Year : 1985 | Volume
| Issue : 3 | Page : 199-200
Bilateral primary herpes simplex keratitis in a neonate
ANU Eye Clinic, Karad, India
S S Dhage
ANU Eye Clinic, Karad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhage S S. Bilateral primary herpes simplex keratitis in a neonate. Indian J Ophthalmol 1985;33:199-200
The virus of herpes forms a rare but interesting neonatal infection. More usually the infant is protected for the first few months of life by circulating maternal antibodies; this, however, is not always so, for the primary attack may appear in early infancy i.e. 2 weeks. The newborn usually acquires the virus (usually herpes & virus hcminis type-2) from the mother's infected genital tract at delivery. Ocular involvement occurs in 20% of cases of neonatal herpes and ranges from mild conjunctivitis to severe retinitis. Bilateral conjunctivitis, dendritic keratitis and stromal keratitis can be seen but are not very frequent findings.
| Cash report|| |
A 30 days old muslim male child was referred by a paediatrician for ophthalmic examination with the complaint of constant crying and not opening both eyes for the last 15 days. On examination, there was no lid oedema, both eyes were quiet and there was no discharge of any kind. In both eyes, the cornea was hazy and lustreless in the central part. Corneal sensations could not be elicited. Fluorescein staining showed bilateral extensive amoeboid corneal ulcers, more on the right side than the left. [Figure - 1] The pupils were of normal size and iris pattern was normal. The patient was afebrile and the overall general condition was normal. There were no vericellifoim cutaneous lesions anywhere around eyes or mouth. Preauricular lymphnodes were not palpable.
The patient was put on 0.1% I.D.U. drops 2 hourly in both eyes. No other local or systemic antibiotic or atropine was given and eyes were not patched. After 3 days the staining was markedly reduced on both sides and the child was comfortable and could open the eyes on his own. The frequency of I.D.U. drops was reduced to every 4 hours. The patient was reviewed again after 3 days when the stain was negative and only superficial corneal haze was left. The instillation of I.D.U. drops was further reduced to every 6 hours with I.D.U. ointment at night and orally Vit C drops (5 drops twice a day) were given. The patient was seen again after 3 days when the eyes were almost normal except a very faint corneal opacity left on the temporal side of each eye. The pupillary area was clear. All local medications were stopped.
| Discussion|| |
Typical H. implex Keratitis even though very rare may appear in the newborn at birth or shortly thereafter. Presumably it is acquired transplacentally or by the ascending route across the fetal membranes or through mother's infected genital tract. In I to 3 years old children, it is the commonest cause of inflammation of the mouth but it is rarely seen (even during fevers) affecting the eye. The primary infection may often be unrecognised or entirely subclinical. Primary infection outside the oral cavity is rare but there are well documented ocular cases, with or without associated oral lesions. Incubation period is 3 to 12 days and it may be accompanied by fever, gastro enteritis and diffuse Lymph adenopathy. Here the patient had solely corneal affection sparing other ocular parts and skin and without any acute systemic illness and responded extremely well to I.D.U. drops alone which helped in confirming the diagnosis therapeutically. No toxic effects of I.D.U. were observed.
| Summary|| |
A case of bilateral primary keratitis due to H Simplex virus in a neonate of 15 days is being reported. I.D.U. drops gave satisfactory result as the most commonly available antiviral agent in such a case.
| References|| |
Duke Elder S., 1977, System of Ophthalmology London Kimpton Vol. VIII Part I Page 118., 309.
Nahmias A.J, Josey W.E. Naib Z.M., 1971, Am. J Obstet. Gynecol. 11 : 825.
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Abraham, M,R, 1977, Pediatrics 16th Edn. Appleton-Century Crofts, New York.
Rodger R.C., 1981, Eye diseases in the tropics Churchill Livingstone, Page 57.
Grayson Merrill, 1983, Diseases of the corneal 2nd Edn., C. V. Mosby Co., Page 153.
[Figure - 1]