Year : 1984 | Volume
: 32 | Issue : 4 | Page : 205--208
Regional hospital prevalence of viral keratitis
AK Khurana, HR Gutain, IPS Parmar
Upgraded Department of Ophthalmology, Medical College Rohtak, India
Professor of Ophthalmology, Medical College, Rohtak (Haryana)
|How to cite this article:|
Khurana A K, Gutain H R, Parmar I. Regional hospital prevalence of viral keratitis.Indian J Ophthalmol 1984;32:205-208
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Khurana A K, Gutain H R, Parmar I. Regional hospital prevalence of viral keratitis. Indian J Ophthalmol [serial online] 1984 [cited 2023 Feb 8 ];32:205-208
Available from: https://www.ijo.in/text.asp?1984/32/4/205/27389
Viral corneal ulcer is a very common and serious external ocular manifestation now a days in westeren countries. It is in fact-said to he the most frequent single cause of corneal opacities and subsequent visual disability and blindness.
Though, the Western literature suggests that viral keratitis is still the less common in tropical and subtropical countries, yet in practice in developing countries like India, where other infections like trachoma are now becoming comparitively less prevalent, the viral corneal ulcer is assuming greater importance. The incidence of viral keratitis in our country has shown a steep rise due to improved socioeconomic changes and following indiscriminately wide spread use of antibiotics and corticosteroids. In other words, viral affections of the cornea are now replacing the bacterial ones. However, there is paucity of data showing the incidence, age and sex distribution, the, recurrences, precipitating causes, seasonal variation, type of lesion and degree of morbidity caused by this ailment in our conditions. In the present study attempt was therefore, made in this direction.
MATERIAL AND METHODS
One hundred and fourteen cases (154 eyes) of viral involvement of cornea who visited in one year (1979-80), were studied. Detailed history of each case was recorded to know the precipitating factors, bilaterality, seasonal variation and recurrences, if any. Thorough ocular examination, including fluorescein staining and slit-lamp examination was done. Each case was followed to note recurrences and visual morbidity. For first three days follow up was done everyday, thereafter on 5th, 10th and 14th day. Further, the patient was also observed for recurrences whenever complained. Disappearance of symptoms and absence of fluorescein staining were noted each time during follow up. Any complication caused by treatment and final visual acuity were recorded.
It was noticed that 0.53% of the total ophthalmic patients who visited us, during this year, were suffering from viral involvement of cornea.
Age and Sex distribution:
[Table 1], shows the age and sex distribution of patients of viral keratitis. It was observed that maximum number of cases (59.6%) were seen in the age group of 21 to 40 years followed by 27.2% cases seen in the age group of 41-80 years. No cases was, however, recorded below ten years of age, in this series.
As shown in [Table 1], out of 114 patients recorded 85 were males (74.8%) and 29 were females (24.4%).
Population distribution :- Majority of patients studied were from professions like teachers, students, mannual workers and technical workers etc., as shown in [Table 2]. Nearly 70% of the subjects studied comprised of rural population.
Seasonal variation :- Eighteen patients (15.8%) gave history of recurrent attacks during summer and seven during winter season.
Precipitating factors :- [Table 3], depicts the various precipitating causes noted. In majority of the cases (75 eyes, 65.8%) some precipitating cause was found leading to the attack of herpes simplex keratitis. Fever was the commonest precipitating cause (64%) followed by trauma which accounted for 12%.
a) Unilateral/bilateral distribution :- 65 % of patients (74 cases) showed unilateral involvement whereas bilateral lesions were seen in remaining subjects. b) Type of lesion :- [Table 4], shows the distribution of different eye lesions in the subjects studied. Dendritic keratitis was the most common lesion found (32 eyes, 20.7%).
Recurrences :- Sixtynine patients (60.5%) gave history of repeated attacks of keratitis amongst them 56 (81%) were males and 13 (19%) females.
Out of 35 cases who had repeated attacks in the same eye the time interval between recurrences varied from 1 to 4 years.
Out of 114 cases (154 eyes) studied only 6 eyes (3.8%) had 6/6 vision after treatment. 98.7% eyes had residual corneal opacity. Out of the 60 treated cases 40% had vision ranging from 1/6 to 6/60 and 20% from 6/24 to 6/36. However, 7 eyes had vision only from P.L. to F.C. at 1 M.
Study demonstrated incidence of viral keratitis to be 0.53% (1:188) of all ophthalmic out patients, which is similar to that reported by Norn (1:196) in 1970'. While Janker gave an incidence of 1:250 of all Ophthalmic patients. Western literature give a low incidence ovviral keratitis in India, but a constant rise has been observed in recent years. This rise may be supurious as a result of fall in incidence of bacterial infections, improved ophthalmic care leading to early diagnosis of viral keratitis and injudicious use of steroids for red eye.
Age and Sex Distribution:
Maximum number of cases (59.6%) were observed in the age group of 21-40 years i.e. the period of life exposed to more stress, strain and trauma. Similar observation have been made by other workers,,. Norn found that 59% case were adults.
In this series male patients wer 74.8% and female 24.6%. Gunderson reported that both sexes are equally affected in the childhood.
Norn reported male/female ratio to be 93:64. Low incidence observed in females in this series may be due to that females are less exposed to trauma and are less particular about their diseases due to social repression of females in theis part of country.
Maximum cases were seen during the summer from June to October. Only 6.1 % patients gave a definite history of recurrence during the winter season. while 18 patients (15.8%) had recurrences only during summer months. Different authors have reported different seasons for the recurrences. Jones reported autmn in England, Liabson and Leopald reported winter in U.S.A. as the recurrence season. In our series large number of cases were found in summer months, the same was reported by Jain. The casues may be dusty and dry weather during summer months. But Janker and Norn could not lied any seasonal variation.
There were 35% bilateral cases. While Gunderson reported only 1% bilateral cases. Other workers have reported an incidence of 9 to 10%,. Increased bilateral cases may be as a result of overall increase in incidence of the disease.
Seventy five cases (65.8%) gave history of some proecipitating cause before the onset of keratitis. majority of cases gave history of malarial fever (64%). Malaria as a precipitating factor has been reported by various authors. Harley and Kaiser found malaria parasite in 56% cases during the attack of her pes keratitis. Thygeson et a1 and Janker reported upper respiratory catarrh as a possible cause of recurrence. In our series 5 patients gave history of recurrent sore throat with common cold preceding the attacks of Herpes Keratitis. Trauma accounted for 12% cases in this series. While Gunderson reported trauma in 5.7% peterhaus in 20% and Thygeson et al in 10% of the patients.
Dendritic Keratitis was commonest (20.7%) followed by geographical ulcer (18.2%) Thygeson et a1 reported dendritic keratitis in 49% cases and geographical ulcer in 17%. In 50% cases of dendritic ulcer central area of cornea was involved. Same was observed by Thygeson et a1. Involvement of central cornea may be due to the reason that this area is richly supplied by nerves. Disciform keratitis was found in 11.6% of cases while Thygeson et a1 reported disciform keratitis in 28.5% cases. The low incidence of disciform keratitis in this series may be due to the early diagnosis and immediate treatment being given to patients now a days. Other lesions observed were mataherpetic keratitis (2.6%), healed herpetic keratitis (3.5%) and phthisic eye with active lesion in other eye (2.6%).
Sixty nine patients (60.5%) gave history of recurrences in the past, while 39.5% cases had only one attack. Thygeson et a1 and Carrol et a1 12 found recurrences in 25% cases only. Number of attacks in a single eye according to Thygeson et a1 varied from 2 to 4, but in the present study, 2 to 7 attacks were observed. Out of the unilateral cases, 57.5% had recurrences within two years of the first attack. While 44.4 % of the 36 bilateral recurrent cases had involvement of other eye within a period of two years.
114 patients (85 males, 29 females) suffering from viral keratitis were studied during the year 1979-80, which comprised about 0.5% of total ophthalmic patients observed during this period. Nearly 1/3rd of the subjects studied showed bilateral involvement. Dendritic keratitis was the commonest active lesion (37.5%) followed by geographical ulcer (18.2%). About 60% patients gave the history of repeated attacks. Some precipitating factor was observed in 2/3rd of population studied and the predominating factor was fewer.
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|11||Carrot, J.M., Martala, L., Liabson, P.R. and Dohlman, C.H., 1967, Am. J. Ophthalmol.. 63:103.|