HSV Dendritic Epithelial Keratitis

Characteristic

• 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

• 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

Treatment

• individually or in combination
  • Topical antivirals
  • Systemic antivirals