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Genital Warts & Corneal Melt = Herpes cause?

Answered by
Michael J Kutryb, MD - Ophthalmology, Cataract Surgery, glaucoma, Laser Vision Correct
Kutryb Eye Institute - Titusville
Our Ask A Doctor Ophthalmology Forum is where you can post your question and receive a personal answer from physicians affiliated with the American Academy of Ophthalmology.
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MedHelp Member's Question
Genital Warts & Corneal Melt = Herpes cause?
by JJJONES, Sep 22, 2009 12:28PM
My sister's eye specialist  has been unable to determine "why" she developed corneal melt.  The typical causes have been ruled out, rheumatoid arthritis, etc.  My online readings indicate corneal melt is often a symptom of the herpes virus - this may be relevant since my sister had several genital warts removed by a cancer specialist on a few occasions.  "Cancer" was not evident as she wasn't treated  with radiation or chemo; she merely has the warts removed and examined by the cancer specialist as needed. To my knowledge, she has not shared ALL of her symptoms with either doctor; therefore, they are unlikely to conclude Herpes as a source of BOTH problems.

My question is this:  Would routine diagnostics for either condition reveal Herpes if it were  present?  She's been prescribed many steroidal treatements for her eye and the warts, and anti-infection medications for her eye, and is on a heavy dose of morphine for two years.  Her family doesn't know WHY morphine is warranted and IF the powerful meds could worsen an underlying herpes condition, if it is present.  

Any thoughts, advice, and/or educational resources are most welcome.  Please share . . .

Thank you.
Doctor's Answer
by Michael J Kutryb, MD, Sep 22, 2009 08:24PM
I don't relate the warts or genital herpes to this melt.  Herpes type 1 (non genital herpes) can be a possible factor and that could be tested for with cultures and blood tests.  Somtimes it can be difficult to prove this as a cause. I have seen corneal melts with automimmune diseases like lupus and rheumatoid arthritis and also after shingles.  A rheumatologist may need to be consulted to look for other possible causes..An ophthalmologist that is a corneal specialist should be able to guide her with her workup and treatment.

MJK MD
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Member Comments (2)
by JJJONES, Sep 23, 2009 10:21AM
To: Dr. MJK:
Thank you for your prompt and informative reply.

Below is my sister's diagnosis and the medicine she takes daily. She has taken morphine at these levels for two years. Our family does not understand WHY the huge doses are prescribed. (Meds prescribed by referring physician not Eye doc or VIN/VAIN doc):

Diagnosis:

VAGINAL INTRAPATHELIA NEOPLASIA 3 (Vin 3)    
VULVAR INTRAPATHELIA NEOPLASIA   3 (Vain 3)  
CORNEAL MELT

Vigamox   0.5 %              1 drop in right eye 4 x a day
Xibrom     0.09 %             1 drop in right eye 2 x a day
Prednisone  60 mg.          1 pill 2 x day
Morphine IR 15 mg.                                1 pill 3-4 a day
Morphine ER 15 mg.                              1 pill 3x a day
Morphine ER 30 mg                               1 pill 2 x a day
Nortriptylene   25 mg.                             1 pill at bedtime
Estradiol     1 mg                                   1 pill day
Naprosyn   500 mg.                               1 pill 2 x day
Furosemide (Lasix)  20 mg.                    1 pill 2 x a day
Hydroxyzine * (only as needed) 10 mg    1 pill every 8 hours
Zantac   150 mg.                                   1 pill daily
Lidoderm * (only as needed) 5 %       1 patch- 12 hours on & 12 hours off (As needed)

(Not taking radiation or chemotherapy, so theres no cancer diagnosis.)

Our family is very concerned about my sister taking all of this medicine.  For comparison purposes, will you please share the typical treatment regimen and medication prescribed for corneal melt?

Thank you in advance for any guidance and insight you may offer.  It is most welcome.
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