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HSV Dendritic Keratitis — RACP Adult Medicine MCQ

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EasyGeneral Internal MedicineHSV Dendritic KeratitisRACP Adult Medicine

A 65-year-old woman with diabetes and CKD stage 3 develops an acute painful red eye. Slit lamp examination reveals dendritic corneal ulceration with fluorescein uptake. What is the diagnosis and treatment?

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Reveal the answer and explanation

Correct answer: A — Corneal abrasion – lubricants only

Dendritic corneal ulceration is pathognomonic for herpes simplex virus (HSV) keratitis. Treatment is topical aciclovir 3% ointment (5 times daily for 14 days) or oral valaciclovir (if topical is not tolerated). Topical corticosteroids are CONTRAINDICATED in epithelial HSV keratitis (they enhance viral replication and can cause corneal perforation). However, corticosteroids are used UNDER OPHTHALMOLOGY SUPERVISION for stromal or endothelial HSV keratitis. Urgent ophthalmology referral is essential. Risk factors for HSV keratitis reactivation include immunosuppression, UV exposure, and stress.

Reference: eTG – 2025 – Ophthalmology; eTG – 2025 – Antibiotic Guidelines