HERPES SIMPLEX KERATITIS

 The first photo is of a herpes simplex dendritic keratitis in a 15 year old male who had been using topical steroid chronically.

The second photo is two days after the start of topical antivirals. 

The third photo below is taken with fluorescein and a Wratten Filter about 6 days after presentation.  There are still epithelial defects but it is improving.

The photo below is taken day 4 as well. The patient is complaining of a little haze in their vision. As expected, a slight infiltrate haze has deepened, representing increased inflammation. Unfortunately, I am uncomfortable adding a steroid to the regimen at this point, considering the epithelial lesions aren’t fully healed.  We are continuing the topical antiviral at this stage and watching very very closely.  As soon as epithelial is healed, we will consider the very judicious use of steroid drops.  

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