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Primary herpes simplex subepithelial dendritic keratitis.

G A Stern, Z S Zam, V J Gutgesell

    American Journal of Ophthalmology
    |April 1, 1981
    PubMed
    Summary
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    This study describes a rare case of herpes simplex virus (HSV) causing subepithelial dendritic keratitis, mimicking epidemic keratoconjunctivitis. Early diagnosis and cautious corticosteroid use are crucial for this unusual presentation of herpetic eye disease.

    Area of Science:

    • Ophthalmology
    • Virology
    • Infectious Diseases

    Background:

    • Epidemic keratoconjunctivitis (EKC) is a common, highly contagious viral eye infection.
    • Herpetic keratitis, caused by herpes simplex virus (HSV), typically presents with different corneal manifestations.
    • Differentiating between these conditions is crucial for appropriate patient management.

    Observation:

    • A 37-year-old male presented with acute follicular conjunctivitis and preauricular lymphadenopathy, initially suspected as EKC.
    • Corneal examination revealed subepithelial dendritic opacities on day eight, atypical for EKC or typical herpetic keratitis.
    • Diagnosis of primary HSV infection was confirmed via viral culture and serological antibody titer rise.

    Findings:

    • This case presents a novel manifestation of HSV infection: subepithelial dendritic keratitis.

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  • The observed corneal lesions were not reproducible in animal models, suggesting an unusual host immune response.
  • Herpetic keratoconjunctivitis with these specific dendritic opacities is clinically challenging to distinguish from EKC.

    • Implications:

    • This finding expands the spectrum of ocular manifestations of herpes simplex virus.
    • Clinicians should consider HSV infection in atypical presentations of keratoconjunctivitis, especially when corneal findings are unusual.
    • Cautious use of corticosteroids is advised in suspected or confirmed cases of herpetic keratoconjunctivitis, particularly when differentiation from EKC is difficult.