Unveiling geographic conjunctival ulcer: a rare clinical presentation of herpetic eye disease

A male patient in his 50s presented with a history of sudden onset redness and pain in the right eye for 15 days. He was under prescription of topical antibiotics, steroids and lubricants by the primary treating ophthalmologist for 2 weeks with reported worsening of symptoms. He was noted to have a visual acuity of 20/32 and 20/20 in the right and left eye, respectively. Clinical examination revealed diffuse conjunctival congestion and a focal area of conjunctival blanching which on fluorescein staining showed multiple geographic conjunctival ulcers. Rose Bengal staining revealed a fine corneal dendrite at the superior limbus. A conjunctival scraping sample was sent for microbiology workup and the patient was started on topical and systemic acyclovir with a presumed diagnosis of herpetic keratoconjunctivitis. On follow-up, the Herpes simplex virus PCR test was noted to be positive. Good clinical response was noted with complete healing of ulcer by the third day of treatment.