Which finding is characteristic of HSV keratitis?

Which finding is characteristic of HSV keratitis?

• A. Hazy cornea with a bacterial ulcer.
• B. Dendritic lesions observed with fluorescein staining.
• C. Pigment spots on the cornea.
• D. Normal cornea with mild injection.

Answer: (B)

Dendritic epithelial ulcers that take up fluorescein dye are the hallmark of herpes simplex keratitis. Under slit-lamp examination with fluorescein, these lesions appear as branching, linear "dendrites" with terminal bulbs, a pattern highly characteristic of HSV infection of the cornea. This distinguishes it from bacterial keratitis, which shows a hazy cornea with a more irregular, non-dendritic epithelial defect and often shows signs of bacterial infection such as purulent discharge; pigmented spots on the cornea are not typical of HSV keratitis, and a normal cornea with only mild injection lacks an epithelial ulcer. Corneal sensation may be reduced in HSV keratitis due to trigeminal involvement, which can further support a viral etiology. Early antiviral therapy and ophthalmology consultation are essential to prevent scarring and vision loss.

Dendritic epithelial ulcers that take up fluorescein dye are the hallmark of herpes simplex keratitis. Under slit-lamp examination with fluorescein, these lesions appear as branching, linear "dendrites" with terminal bulbs, a pattern highly characteristic of HSV infection of the cornea. This distinguishes it from bacterial keratitis, which shows a hazy cornea with a more irregular, non-dendritic epithelial defect and often shows signs of bacterial infection such as purulent discharge; pigmented spots on the cornea are not typical of HSV keratitis, and a normal cornea with only mild injection lacks an epithelial ulcer. Corneal sensation may be reduced in HSV keratitis due to trigeminal involvement, which can further support a viral etiology. Early antiviral therapy and ophthalmology consultation are essential to prevent scarring and vision loss.