Images in Clinical Medicine
Kim Eagle, M.D., Editor
Herpes Simplex Virus Corneal Dendrite
N Engl J Med 1995; 333:1743December 28, 1995
- Article
Figure 1 A herpes simplex virus corneal dendrite is revealed by slit-lamp examination with fluorescein (upper panel) and fluorescein plus rose bengal (lower panel, high power) in a 70-year-old man who reported two days of pain and redness in his right eye. His visual acuity was minimally diminished. The lids (A) are normal; the conjunctiva (B) is injected; the diagnostic dendrite (C) results from a branching pattern of desquamation of infected corneal epithelial cells. Desquamated cornea stains with fluorescein, whereas the remaining infected epithelial cells at the margin of the dendrite stain brilliantly with rose bengal. This epithelial infection differs from a corneal ulcer, which involves infection and erosion of the corneal stroma. The iris (D) and pupil (E) are normal. The leading edge of the slit-lamp beam (F) reveals the sloping contour of the corneal surface and suggests that the depth of the anterior chamber is normal. The patient was successfully treated with a 14-day course of topical trifluridine, an antiviral agent, and had no permanent visual impairment.
Kim Eagle, M.D.
Thomas A. Ciulla, M.D.
Kit Johnson
Massachusetts Eye and Ear Infirmary, Boston, MA 02114
