A 35-year-old man comes to the emergency department with pain in his right eye of 3 days' evolution. Biomicroscopic examination of the anterior segment shows, after fluorescein staining, a central corneal ulcer in the form of a dendrite. What is the diagnosis?
Dendritic corneal ulcer is typical of herpes simplex keratitis. It presents with pain, not too striking, and scarce or absent red eye. There are ulcers resembling dendrites that may confuse us in the diagnosis. These pseudodendrites are found in herpes Zoster and in corneal abrasions in resolution. Although in practice we should pay attention to the shape of the dendrite (the true dendrite is deeper and has terminal bulbs at the end of each branch), and pay attention to the evolution of the pain (in the pseudodendrite after abrasion the pain should improve), when answering a MIR question it is simpler: if it is a dendrite, the first thing we have to think is herpes. Fungal and bacterial keratitis have corneal infiltrates. And glaucomatocyclitic crisis (Posner Schlossman syndrome) is a type of idiopathic hypertensive anterior uveitis, which does not present with ulceration.
Herpetic keratitis.
Corneal abrasion.
Fungal keratitis.
Bacterial keratitis.
Glaucomatocyclic crisis.
Dendritic corneal ulcer is typical of herpes simplex keratitis. It presents with pain, not too striking, and scarce or absent red eye.
if it is a dendrite, the first thing we have to think is herpes.
Fungal and bacterial keratitis have corneal infiltrates.
Fungal and bacterial keratitis have corneal infiltrates.
glaucomatocyclitic crisis (Posner Schlossman syndrome) is a type of idiopathic hypertensive anterior uveitis, which does not present with ulceration.