A 28-year-old presents with recurrent corneal dendrites, decreased corneal sensation, and a history of atopic dermatitis. PCR on corneal scraping is positive for HSV-1. Which topical antiviral is preferred for acute HSV stromal keratitis (disciform)?

• A Topical acyclovir 3% ointment alone
• B Topical corticosteroid (prednisolone) with prophylactic antiviral cover ✓
• C Topical trifluridine + oral acyclovir 400 mg BD
• D Topical ganciclovir gel alone

Explanation

HSV disciform (immune) stromal keratitis is immune-mediated (antigen-antibody complex deposition) rather than directly viral in the stroma; therefore, topical corticosteroids are the mainstay of treatment, always given with topical antiviral prophylaxis (acyclovir ointment) to prevent viral replication. Epithelial HSV dendrites are treated with topical antivirals alone (no steroids). The HEDS (Herpetic Eye Disease Study) demonstrated that topical steroids with antiviral cover are superior to antiviral alone for stromal keratitis.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.