Game 10
set-up
Solve
in
1
Your patient comes in presenting with the following:
- Dendritic Ulcer
- Decreased vision
- Foreign body sensation
- She was prescribed acyclovir
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All other features are for you to observe
Solve
in
2
Previously, she was diagnosed with herpetic keratitis. It was noted that the dendritic lesion only occurred in the right eye.
​
She returned after complaining about recurrent pain in the left eye. Decreased VA was observed. A similar shape in the photo was observed in the left eye, however with a much smaller dendritic lesion. All other features are identical or present.
last
chance
She was treated with cyclosporin A. This prevent recurrence.
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Previous visits, treated with acyclovir did not work. This should be noted.
The
answer
Thygeson's Keratitis
+ Potential (unconfirmed) HZV Keratitis
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- Dendritic presentation does not seem to resemble simplex, and is also in a cracked glass pattern
- Underlying grey white dots scatter the cornea
- Recurrence continues to occur, even after the herpetic keratitis was treated
- Thygeson's has some treatment effect with cyclosporin A