A 50-year-old patient with a history of herpes zoster ophthalmicus (T10 dermatome rash 3 months ago) now presents with painless corneal anesthesia, persistent epithelial defect, and stromal melting. There is minimal anterior chamber reaction. What is the most likely diagnosis?
- A Nummular keratitis
- B Neurotrophic keratopathy ✓
- C Disciform keratitis
- D Necrotizing retinitis
Correct answer: B. Neurotrophic keratopathy
Explanation
Neurotrophic keratopathy occurs months after herpes zoster ophthalmicus due to damage to the trigeminal nerve, causing corneal anesthesia, persistent epithelial defect, and sterile stromal melting with minimal inflammation. Nummular keratitis occurs early (days-weeks) as disc-shaped stromal infiltrates. Disciform keratitis presents with stromal edema and keratic precipitates. Necrotizing retinitis involves the retina, not the cornea.
Reference: AAO BCSC Section 8: External Disease and Cornea, 2023-2024 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.