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Ocular involvement in primary herpes simplex infection is usually in the form of follicular conjunctivitis, blepharitis, and sometimes corneal involvement in the form of superficial punctuate keratitis, dendrite, or (rarely) geographical ulcer.1
We report a case of dendritiform lesion in the conjunctiva in a young girl with primary herpes simplex infection. To the best of our knowledge, conjunctival dendritiform lesion has not been reported before in primary herpes simplex infection.
A 20 year old girl presented to our outpatient department with complaints of redness and discomfort in her right eye of two days’ duration. She gave a history of fever of one week’s duration followed by appearance of vesicles at the right side angle of the mouth and on the right upper lid. Past ocular and systemic history was unremarkable.
Visual acuity was 6/6 unaided in both the eyes. There were vesicles at the angle of the mouth (fig 1A) and on the right upper lid. Slit lamp examination of the right eye with fluorescein staining revealed a dendritiform pattern of staining in the lower bulbar conjunctiva (fig 1). Cornea was clear and rest of the anterior segment was unremarkable. Left eye examination was unremarkable. Fundus examination in both the eyes was within normal limits. The patient was advised to use topical acyclovir 3% eye ointment five times a day and tablet acyclovir 400 mg five times a day.
On follow up after two days, there was superficial punctuate keratitis in the inferior half of the cornea in the right eye. The patient was asked to continue the same medication. One week later, the vesicles were absent and the conjunctiva and cornea were clear. The medication was discontinued.
Darouger et al, in a study of primary herpes simplex ocular infection, found 64% of the patients to be over fifteen years of age.2 Follicular conjunctivitis (7%), blepharoconjunctivitis (16%), and corneal dendritic ulcers (15%) were some of the lesions reported. Appearance of a dendritic ulcer on the conjunctiva, to the best of our knowledge, has not been reported in primary herpes simplex infection.
Dendritic lesions on histopathological study show that they are composed of round epithelial cells and variable sized syncytia containing bizarre shaped nuclei. The epithelial cells contain viral DNA.3 Recurrent infection with the virus in the form of epithelial keratitis commonly produces dendritic lesions on the cornea.1
Conjunctival dendrite is an interesting and apparently rarely reported lesion.
The authors have no proprietory interests in the products mentioned in the article.