Corneal Dendrites
A 34-year-old man with no clinically relevant medical history presented to the emergency department with 3 days of photophobia, tearing, and the sensation of having a foreign body in his right eye. A slit-lamp examination with fluorescein staining revealed corneal lesions in a pattern of dichotomous branching with terminal bulbs. Such lesions are typical in herpes simplex epithelial keratitis, which is caused by active replication of the virus in the corneal surface. The patient was treated with acyclovir 3% ophthalmic ointment, applied five times a day for 14 days. Epithelial keratitis is a common presentation of ocular infection by the herpes simplex virus. It may occur as a primary infection but is more commonly due to the reactivation of latent virus. The condition resolves spontaneously in the majority of cases. Given the low toxicity of antiviral therapy and the potential for corneal complications from herpes simplex virus infection, antiviral therapy is typically given. In this case, follow-up examination revealed complete resolution of symptoms and no corneal ulceration; the visual acuity was unaffected.
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