HSV Dendritic Epithelial Keratitis

Herpes simplex dendritic ulcer.


  • Begins as discrete punctate epithelial keratitis which may then coalesce to form dendritic-shaped lesions.
  • May be single or multiple, with typical "terminal bulb" at the tips of dendrite branches.
  • Devitalized cells surrounding the edge of the dendritic ulcers best stained with rose bengal.
  • Fluorescein dye may pool in the central ulceration of epithelial dendrites
Herpes simplex dendritic epithelial keratitis
  • Common viral infection.

Clinical Features

  • Unilateral and 10% bilateral.
  • Symptoms: tearing, foreign body sensation, photophobia, ocular pain and blurring of vision
  • Signs:
    • First present as punctate keratitis that may become progressive
    • Pathognomonic single or multiple branching dendritic ulcers possibly progressing to wider geographic ulcers
    • May present also as stromal keratitis, endothelitis, uveitis and retinitis


  • individually or in combination
    • Topical antivirals
    • Systemic antivirals