Which finding is characteristic of HSV keratitis?

• A. Hazy cornea with a bacterial ulcer.
• B. Dendritic lesions observed with fluorescein staining.
• C. Pigment spots on the cornea.
• D. Normal cornea with mild injection.

Answer: (B)

Dendritic epithelial ulcers that take up fluorescein dye are the hallmark of herpes simplex keratitis. Under slit-lamp examination with fluorescein, these lesions appear as branching, linear "dendrites" with terminal bulbs, a pattern highly characteristic of HSV infection of the cornea. This distinguishes it from bacterial keratitis, which shows a hazy cornea with a more irregular, non-dendritic epithelial defect and often shows signs of bacterial infection such as purulent discharge; pigmented spots on the cornea are not typical of HSV keratitis, and a normal cornea with only mild injection lacks an epithelial ulcer. Corneal sensation may be reduced in HSV keratitis due to trigeminal involvement, which can further support a viral etiology. Early antiviral therapy and ophthalmology consultation are essential to prevent scarring and vision loss.