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Introduction
Case
A 24 year old previously healthy male presents to the eye clinic with symptoms of red eye, tearing, pain and photophobia in his right eye. He says the symptoms developed over the course of the day yesterday, and were much worse upon wakening today. He has had no previous similar episodes, and complains of no vision loss, rashes, or recent upper respiratory infection. On examination visual acuity is 6/9 in the right eye and 6/6 in the left eye. Anterior segment exam reveals the following:
What is the most likely diagnosis?
herpes zoster
INCORRECT- although herpes zoster can manifest as a dendritic appearing lesion, it is unlikely to stain positive with fluorescein. In addition, herpes zoster is most common in older individuals and is commonly associated with a painful rash.
herpes simplex keratitis
CORRECT
viral keratoconjunctivitis
INCORRECT- viral keratoconjunctivitis is a common cause of red eye and water discharge, but would not produce dendritic appearing ulcers. It is commonly associated with an upper respiratory tract infection and painful preauricular nodes.
fungal keratitis
INCORRECT- the lesion does not have the appearance of a fungal ulcer
Herpetic eye disease is a major worldwide cause of vision impairment. In developed countries the incidence of ocular herpes simplex virus (HSV) infection has been reported at 21-31 per 100 000 people per year.1, 2 In the United States alone, over 300, 000 new cases of ocular HSV are reported annually.3 Although HSV can affect virtually all ocular and orbital tissue, this module will focus on corneal involvement, or herpes simplex keratitis (HSK).