Cornea Case

Cornea

Case Presentation

A 5 year-old boy with history of atopy was recently started on systemic prednisone for a flare up of his eczema. His mother brought him in because his right eye is red and painful. He had similar episode during last summer’s vacation on the beach with his family. The right eye is injected. Staining of the cornea with fluorescein shows the following pattern.

Corneal sensation loss, hypophasia is common in this case / violent dendritic ulcer

Spot diagnosis photo - antiviral ointment treatment

Clinical Features

• Immunosuppressive state
• Recurrent
• Typical dendrite that stains with fluorescein
• ?? Corneal sensation

Diagnosis

Dendric ulcer herps simplex keratitis or viral corneal ulcer or dendritic ulcer.

Dendritic ulcer (Herpes simplex keratitis)

Differential Diagnosis

• Acute red painful eye
• Decrease corneal sensation
• Other corneal dendritis

DD of acute painful visual loss:

• Other Keratitis
• Corneal FB
• Corneal wound
• Uveitis
• ACG (acute glaucoma)
• Orbital cellulitis
• Endophthalmitis or pan ophthalmitis

Investigations

• Slit lamp examination: fluorescein stain

• Corneal sensation
• NB: in bacterial and fungal keratitis; add corneal scraping for culture and AB sensitivity tests.

Treatment

As in cornea lecture