Herpes simplex virus keratitis with stromal involvement characteristically shows which pattern on slit-lamp examination?
- A Inferior punctate keratitis with follicular conjunctivitis
- B Branching dendritic ulcer on anterior surface without stromal involvement
- C Geographic epithelial ulceration with heaped-up edges, followed by necrotising stromal keratitis or disciform keratitis ✓
- D Band-shaped calcific keratopathy
Correct answer: C. Geographic epithelial ulceration with heaped-up edges, followed by necrotising stromal keratitis or disciform keratitis
Explanation
HSV keratitis progresses from epithelial disease (dendritic ulcer with terminal bulbs) to stromal disease in two forms: necrotising stromal keratitis (direct viral cytopathic effect — deep stromal necrosis with opacity, vascularisation) and disciform keratitis (immune-mediated — discoid central stromal oedema with Descemet's folds and Khodadoust line in the endothelium). Geographic ulceration represents a large expanded dendritic lesion. Topical steroids are contraindicated in epithelial HSV but used with antiviral cover in disciform keratitis.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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