This guideline last updated 18/08/2023 13:13:27

Differential diagnosis

• Herpes zoster keratitis
• Bacterial keratitis
• Fungal keratitis
• Acanthamoebic keratitis
• In a contact lens wearer, always consider acanthamoeba keratitis
• Healing corneal epithelial defect

Possible management by Optometrist

Treatment

• PoM in non-contact lens wearing adults and where HSK is confined to the epithelium (dendritic), commence antiviral therapy with one of the following:
  • Aciclovir 3% ointment 5x daily for one week
  • Or Ganciclovir 0.15% ophthalmic gel 5x daily for one week
• Instruct the patient to return in one week
  • If the dendritic ulcer has not healed
    • Instruct the patient to continue using the treatment five times a day and phone the Ophthalmology department to arrange an appointment (or follow local HB protocols where in place) 
• If the dendritic ulcer has healed
  • Instruct the patient to reduce the treatment to three times a day for another seven days and then STOP (or follow local HB protocols where in place)

Advice

• Discharge patient with offer to review, if symptoms recur

Management Category

• Refer urgently (within one week) to ophthalmologist if
• Epithelium has not healed after seven days
• Emergency (same day) referral if
• Stroma involved
• Anterior uveitis
• Raised intraocular pressure
• Children
• Contact lens wearer
• Bilateral cases

Possible management by Ophthalmologist

• Topical and/or systemic Antivirals
• Topical steroid if epithelium intact