Stromal Herpetic Keratitis
In this form of herpetic keratitis, there will be inflammation of corneal stromal layer, which is the middle layer of the cornea without the involvement of epithelial layer.
This inflammation can be due to viral replications or due to hypersensitivity and immune reactions or can be due to both.
Types and Signs of Stromal Herpetic Keratitis
1- Stromal opacity and haziness which is called interstitial keratitis.
2- Stromal opacity and haziness in a disc shape with epithelial and stroma edema and also deposition of cells in the endothelial layer of the cornea. This form is called disciform keratitis. This form can also be associated with iridocyclitis.
3- Diffuse stromal opacity, corneal melting, epithelial defects and stromal neovascularization. This form is called stromal necrotic keratitis. This form is rapidly progressive and can be misdiagnosed as bacterial keratitis.
Treatment of Stromal Herpetic Keratitis
In stromal Keratitis, topical steroid such as pred forte eye drops and antiviral medications can be very helpful in controlling the disease
Some theories said that stromal keratitis is not an active infection of the virus itself but it is a disease due to immune activities and hypersensitivity against the virus antigen and that’s why steroid is very helpful in the disease.
Your eye doctor will determine the dose and frequency of topical steroid. Antiviral medications such as Acyclovir can be used as topical medication but no longer than 2 weeks due to corneal toxicity and also these medications can be used as oral antiviral.
It is advisable to use long term oral antiviral medication (unless the patient has contraindications) to decrease the recurrence rate of stromal keratitis but the final decision will be made by your eye doctor.