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HSV Keratitis — SCE Infectious Diseases MCQ

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EasyInfection Prevention & ControlHSV KeratitisSCE Infectious Diseases

A 38-year-old woman develops herpes simplex keratitis (dendritic ulcer confirmed on slit-lamp examination). She wears contact lenses. What is the first-line treatment?

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Correct answer: E — Topical Aciclovir 3% eye ointment five times daily until 3 days after healing

HSV dendritic keratitis is treated with topical Aciclovir 3% eye ointment five times daily, continued until 3 days after complete epithelial healing (typically 10–14 days total). Topical corticosteroids alone are absolutely contraindicated in epithelial HSV keratitis as they promote viral replication and corneal melting. Oral antivirals may be added for stromal keratitis or severe disease. Urgent ophthalmology review is required. Contact lens wear should be discontinued until fully healed.

Reference: NICE CKS 2024 – Herpes simplex eye infections; RCOphth 2023 – Corneal infections