![]() ![]() HSV, however, doesn’t always present this way. “The virus bounces from cell to cell, so each lesion develops one cell at a time, which is why you get this linear lesion because there are cells falling out and virus cells filling in,” Dr. “Within approximately 24 hours, these vesicles coalesce to form the classic dendrite that most ophthalmologists recognize.” “Vesicles should not be confused with punctate epithelial erosions, which stain positively with fluorescein,” Dr. Vesicles will form and appear as small, raised lesions at first and will not stain with fluorescein. Chan, M.D., professor of ophthalmology, University of Toronto. True HSV also progresses in stages, said Clara C. Clara Chan, M.D., and Mark Mannis, M.D., give us their insights for the examination of the patient with a “dendrite.” In addition, the label of HSV is often permanently attached to the patient.Ī detailed history, careful slit lamp examination, and close monitoring of the clinical course will assist the clinician in determining the correct diagnosis and treatment for these challenging patients. These patients are often placed on topical antivirals, which leads to delayed epithelial healing and persistence of this pseudodendrite. It is very common to see patients with healing epithelial defects or neurotrophic epitheliopathy present with a “dendrite” or a branching epithelial lesion. There are many other “dendritic” lesions of the corneal epithelium that are not due to HSV and have been referred to as “pseudodendrites.” It is important for clinicians to realize that a dendrite (referring to the shape) is not always the infectious epithelial lesion of HSV. When clinicians see a “branching treelike figure” in the corneal epithelium, the most immediate thought is herpes simplex virus (HSV) keratitis. The term dendrite is defined as a branching treelike figure. ![]()
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