Corneal blindness treatment

Herpes simplex keratitis (HSK) is caused by HSV type 1 in adults and is one of the most common infectious etiologies of blindness. It is second only to trauma as a cause of corneal blindness in the United States, where an estimated 50,000 new or recurrent cases are seen each year. Recurrent HSK can be reactivated by many factors in addition to those listed above. Reactivation has been reported in patients after penetrating keratoplasty, argon laser trabeculoplasty, Nd YAG laser peripheral iridotomy, or treatment with excimer lasers, including cases in which ocular herpes had not occurred previously. It is important to realize that because most patients have latent HSV it is possible for a reactivation to occur despite a negative history of a primary infection. 

Ophthalmologic effects Optic neuropathy or neuritis may occur at any time following initiation of therapy, in some cases, visual impairment has progressed to permanent blindness. Corneal microdeposits appear in virtually all adults treated with amiodarone. They give rise to symptoms such as visual halos or blurred vision in as many as 10% of patients. Corneal microdeposits are reversible upon reduction of dose or drug discontinuation. Asymptomatic microdeposits are not a reason to reduce dose or stop treatment. Some patients develop photophobia and dry eyes. Vision is rarely affected and drug discontinuation is rarely needed. 

The duration of treatment for skin diseases is often longer than it is for malaria, and therefore, dose-related toxicities are important. The most serious toxicities are ophthalmological. Reversible alterations include ciliary body dysfunction and corneal changes with edema and deposits. Irreversible retinopathy also occurs however, it is less common with quinacrine than with the other two drugs. Toxicity may be asymptomatic, but the earliest symptoms are night blindness, scotoma, or tunnel vision. 

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