A patient presents with a corneal ulcer showing a dendritic (branching) pattern with terminal end bulbs on fluorescein staining. The ulcer has a geographic pattern on further enlargement. What is the most likely causative agent and first-line topical treatment?
- A Acanthamoeba; topical PHMB
- B Aspergillus; topical natamycin
- C Herpes simplex virus type 1; topical acyclovir or ganciclovir ✓
- D Moraxella; topical tobramycin
Correct answer: C. Herpes simplex virus type 1; topical acyclovir or ganciclovir
Explanation
The dendritic ulcer with terminal end bulbs is the hallmark of HSV epithelial (dendritic) keratitis, caused by herpes simplex virus type 1 reactivation in the cornea. The ulcer enlarges into an 'amoeboid' or geographic pattern. First-line topical treatment is acyclovir 3% eye ointment five times daily or topical ganciclovir gel; oral acyclovir is an alternative. Topical steroids are contraindicated in epithelial disease as they promote viral replication and can cause geographic ulceration.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.