For a patient presenting with suspected keratitis, significant pain, and photophobia, the primary approach should be urgent referral for specialist assessment NICE CKS. All cases of suspected ocular herpes simplex infection, which can manifest with such severe symptoms, require same-day assessment and specialist management by eye casualty or an emergency eye service NICE CKS. It is important not to initiate drug treatment while awaiting this specialist ophthalmology assessment NICE CKS.
To manage the patient's symptoms, advise the use of simple oral analgesia to alleviate discomfort NICE CKS. Ocular lubricants can also be used for symptom relief NICE CKS. For photophobia, patients may find some relief by keeping the eye shut, wearing sunglasses, or staying in low light NICE CKS.
Certain treatments are not recommended in this context. Prescription of cycloplegics, such as cyclopentolate, is not recommended as they do not improve healing or pain management and can worsen glare NICE CKS. Repeated administration of topical anaesthetics is absolutely contraindicated for any corneal injury, as this has been shown to delay corneal wound healing, mask worsening symptoms, and can be toxic to the corneal epithelium NICE CKS. Topical analgesics (NSAIDs) are also not recommended NICE CKS. Routine use of eye patches is not supported by evidence NICE CKS.