Clinical History:

A 41-year-old woman has had increasing pain in her right eye over the past day. She says it feels as though something were scratching it. Her vision in that eye is blurred. Her left eye is unaffected. She has had similar episodes in the past.

Slit Lamp and Microscopic Pathology:

The lesion is a "dendritic ulcer" that has a tree-like branching pattern. This is typical for herpes simplex virus infection. Microscopically, there is ulceration of the epithelium and stroma, with chronic inflammation.

Questions:

1. What is the diagnosis?

This is herpetic keratitis with corneal ulceration and extension into the stroma. There are no specific risk factors for this form of herpes simplex virus (HSV) infection.

2. How is this condition treated?

Topical acyclovir is applied. Vidarabine and trifluridine are alternative agents with similar effectiveness. When stromal involvement is present with keratitis, then corticosteroid drops may also be needed. This condition requires prompt diagnosis and close supervision and observation to make sure that treatment is adequate.

3. What is the prognosis?

If this condition is diagnosed early, then treatment is very effective, with minimal scarring of the cornea. If keratitis progresses, there can be perforation of the cornea. This condition tends to be recurrent, so patients should be made aware that they must seek treatment immediately with future episodes.