Dendritic ulcers are the most common presentation of HSV keratitis. Prominent features of a dendritic ulcer include a linear branching pattern with terminal bulbs, swollen epithelial borders, and central ulceration through the basement membrane. Giemsa stain – Scrapings of the corneal or skin lesions show multinucleated giant cells. Keratitis caused by HSV is the most common cause of cornea-derived blindness in developed nations. Tzanck smear, i.e.Papanicolaou staining of corneal smears, show multinucleated giant cells and intranuclear inclusion bodies, however, the test is low in sensitivity and specificity. Herpes simplex ulcers show a typical dendritic pattern of staining. Rose-Bengal dye is also used for supra-vital staining purposes, but it may be very irritating to the eyes.
Herpes Simplex Virus is a very common viral infection that has been reported to be present in the trigeminal ganglion of nearly 100 of patients greater than age 60 at autopsy. Corneal scrapings of HSV keratitis prepared with Giemsa stain may reveal the presence of intranuclear viral inclusion bodies. The clinical diagnosis of HSV may be suggested by the presence of the multiple arborizing dendritic epithelial ulcers with terminal bulbs. The most common pattern of infection is blepharoconjunctivitis that heals without scarring. Dendritic ulcer is the classic herpetic corneal lesion, caused by replicating virus. The borders of the lesion are slightly raised and grayish and consist of HSV-infected cells that stain with rose bengal (RB) dye. Although HEDS did not show any statistically significant difference in visual outcome with the use of corticosteroids, they do accelerate resolution of HSV ocular infection. HSV keratitis is the most common corneal infection in the United States. Nonetheless, reappearance of anterior stromal inflammation in exactly the same location and pattern confirmed that our apparent clinical cure had simply been suppression of the active process to subclinical levels.
With a herpes simplex infection they will often see a small ulcer (erosion) on the cornea. The typical ulcer which develops is called a dendritic ulcer. Dendritic means branching. Nongenital herpes simplex virus type 1 is a common infection usually transmitted during childhood via nonsexual contact. Fluorescein stain with a ultraviolet light may show a classic dendritic ulcer on the cornea (Figure 47). However, if the pattern of the lesions is not specific to HSV, its diagnosis can be made by viral culture, PCR, serology, direct fluorescent antibody testing, or Tzanck test. It is also indicated for treating HSV keratitis that has not responded to idoxuridine or vidarabine (Vira-A, Parke-Davis). The centers of these ulcers typically stain brightly with fluorescein, while the edges stain well with rose bengal. Some studies show that it is as effective as Viroptic, vidarabine or idoxuridine in treating HSV keratitis.
Herpes Simplex Virus Keratitis
So, in this article, I’ll limit the discussion to herpes simplex and herpes zoster. 4 In its epithelial form, dendritic keratitis is the most common presentation to the primary care optometrist. Confusion of these lesions with pseudodendrites is a common problem that can best be solved by remembering the two key features of the classic dendritic lesion: True dendritic lesions show arborization and terminal end bulbs. Increased redness, pain, infiltrates and corneal staining, despite improvement in the dendritic lesion, suggest drug toxicity. Ito cells can be selectively stained with gold chloride, but their distinguishing feature in routine histological preparations is the presence of multiple lipid droplets in their cytoplasm. Herpes simplex ulcers show a typical dendritic pattern of staining. A corneal ulcer is an erosion or open sore in the outer layer of the cornea the clear structure overlying the iris (which is the colored part of your eye). Herpes simplex ulcers show a typical dendritic pattern of staining. A gram stain and Giemsa stain are negative for organisms. Infection of the conjunctiva by HSV typically following vesicular eyelid eruption herpes labialis Evidence & References Show References. Cornea may initially show coarse, punctate, superficial punctate keratitis-like lesions, which usually coalesce to form linear or dendriform appearance (Fig. Typical dendritic keratitis.