Domanda n. 22
A 23-year-old woman presents with a 3-day history of blurred vision in the left eye. There is no history of any other ocular or medical disease. The slit-lamp appearance is shown in the figure.

 

Herpes simplex dendritic keratitis

The most correct statement concerning this condition is
 1 The condition is a geographic ulcer.
 2 Topical corticosteroids and topical antivirals should be instituted immediately.
 3 The condition should be treated with topical antiviral medication.
 4 Oral acyclovir should be instituted immediately.
 
 
 
 
RISPOSTA ESATTA: 3

Discussion

The figure demonstrates herpes simplex dendritic keratitis. This probably represents a recurrence of the virus, which had been latent within the trigeminal ganglion, although it could represent the primary infection with the virus.

Appropriate treatment should include the institution of topical antiviral agents (such as trifluridine) with possible epithelial debridement. If untreated, a dendrite can progress to a larger geographic ulcer.

Topical corticosteroids are not indicated in the treatment of herpetic dendritic or geographic keratitis, as they can result in further worsening of the infection. The use of oral acyclovir may be helpful for some forms of dendritic keratitis but would not be preferred for the initial presentation of the disease in an otherwise healthy patient.1

Reference
1. Schwab IR: Oral acyclovir in the management of herpes simplex ocular infections. Ophthalmology 1988;95:423-430.