Three weeks after herpes zoster ophthalmicus rash, a 50-year-old woman develops raised grey branching lesions on the cornea. Rose bengal stains the lesions brightly while fluorescein shows no pooling beneath them. Which feature confirms these are zoster mucous plaques and not HSV dendrites?
- A Elevated plaques without epithelial loss ✓
- B True epithelial excavation beneath the lesion
- C Terminal end bulbs at the branch tips
- D Sharp reduction in corneal sensation
Correct answer: A. Elevated plaques without epithelial loss
Explanation
Zoster mucous plaque keratitis produces elevated branching plaques composed of mucus and cellular debris sitting on intact epithelium, hence rose bengal stains them and fluorescein does not pool. HSV dendrites are true epithelial ulcers with terminal bulbs, so they stain with fluorescein centrally and show excavation. Both conditions reduce corneal sensation.
Reference: Yanoff and Duker Ophthalmology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.