Figures 1-3. This is the left eye of a patient with a history of herpes zoster ophthalmicus OS
Questions and Answers
1. What is your diagnosis? Answer: The central round epithelial defect with heaped up margins in the setting of a past history of herpes zoster ophthalmicus is highly suggestive of a neurotrophic epithelial defect.
2. What corneal examination test is important in confirming the diagnosis? Answer: Testing of corneal sensation is essential to confirm the diagnosis. The corneal sensation OS was completely absent in this patient.
3. What medical conditions are associated with this corneal finding? Answer: A history of herpes simplex keratitis or herpes zoster on the same side of the neurotrophic epithelial defect is common. Other associated conditions that need to be considered in the differential diagnosis include topical anesthetic abuse and crack cocaine abuse. Conditions affecting the fifth cranial nerve, such as neurosurgery, cerebellopontine angle tumors, and pontine stroke, can also result in corneal anesthesia and epithelial breakdown.
4. What complications may result FROM this condition? Answer: Epithelial breakdown can lead to non-infectious and infectious corneal ulcers. In severe cases, corneal perforation may result.
5. How would you manage this condition? Answer: Mild cases with some preservation of corneal sensation may be treated with antibiotic ointments, artificial tears, and frequent follow-up. More severe cases require bandage contact lenses with antibiotic coverage. Not uncommonly, a lateral tarsorrhapy may be necessary to prevent epithelial breakdown.