A 30-year-old woman has a branching linear corneal lesion with terminal bulbs, staining positively with fluorescein, with reduced corneal sensation below the lesion. Which drug is the correct first-line topical therapy?

• A Topical prednisolone acetate 1%
• B Topical atropine alone
• C Topical natamycin 5%
• D Topical acyclovir 3% ointment ✓

Explanation

The dendritic ulcer with terminal bulbs and regional hypoesthesia is epithelial herpes simplex keratitis, and topical acyclovir 3% five times daily (or ganciclovir gel) is standard first-line therapy. Topical corticosteroids are contraindicated in active epithelial disease because they promote viral replication and geographic ulceration, so prednisolone is the trap option here. Natamycin treats fungal keratitis, and atropine is only an adjunct for associated uveitis or ciliary spasm.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.