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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 10788
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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need possible diagnosis..pain in eye, discharge, sensitivity..herpes

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need possible diagnosis for daughter travelling in Africa. Symptoms: pain in eye, discharge, sensitivity to light. She had occular herpes many years ago. Could it be a recurrence? what to do until she gets back to UK? Is this an emergency? Thanks
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Dr. Rick :

Hi. I'll be happy to help you with your question.

Dr. Rick :

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With the history of ocular herpes it is very possible that the symptoms you are describing could be from a recurrence. As you may know ocular herpes can recur at any time, much like a cold sore. It can cause uveitis (swelling inside the eyeball), corneal ulcer (infection of the clear, center part of the eye), retinitis (damage to the photoreceptors in the back of the eye) or conjunctivitis (less serious). It is also possible, especially if your daughter wears contacts, that she is suffering from a bacterial infection of her eye (corneal ulcer).

 

The treatments for your daughters symptoms depend upon an accurate diagnosis, which requires an examination with a slit lamp, which would best be done by an ophthalmologist. Because her symptoms, which are consistent with a serious condition -- and should be evaluated ASAP-- require very different treatment based on clinical findings it is difficult to give advise on what she should do in a remote location.

 

Depending on her findings, treatment for recurrent herpes should be treated with viroptic 1% drops, one drop 9x/day or vidarabine 3% ointment 5x/day along with scopolamine 0.25% drops 3x/day.

 

If she has a corneal ulcer that would be treated with antibiotics, hopefully after a culture had been taken to determine what type of bacteria was causing the infection. Treatment would need to start right away, without waiting on the culture results with a broad spectrum drop such as moxifloxacine every hour around the clock. If the ulcer is near the visual axis or has other clinical findings of being "nasty" special, very, very strong antibiotics should be made up by the doctor and used every 30 minutes, alternating drops, around the clock. In these cases I use fortified Gentamicin (15mg/ml) alternating with fortified Vancomycin (25 mg/ml) and re-evaluate the patient at least twice a day.

 

So what is the take home message? Yes, the symptoms your daughter is describing to you could indicate a recurrence of her herpes. It could also be the symptoms of a corneal ulcer or other serious intraocular inflammation. In any event she should make every effort to be seen by an ophthalmologist, or any doctor at all if an ophthalmologist is not available, ASAP.

 

I would be happy to review any findings that your daughter gets from Africa and help the local physician choose the best treatment possible for her. To do this, just post a question and put it to my attention. I will be online most of the weekend.

 

I hope that this information was helpful for you. Please, allow me get credit for my time and effort in assisting you and press the ACCEPT button for this assist. I will be glad to answer additional questions until you are satisfied. Thank you very much.

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