This photo exhibits multiple branching epithelial dendritic lesions due to herpes simplex virus (HSV). This particular patient had a history of herpetic keratitis, and reactivation of the virus was likely due, in part, to immunosuppression from the initiation of systemic chemotherapy for metastatic adenocarcinoma.
Not all cases of HSV keratitis have the large, arborating brightly staining dendrites seen in classic text-book examples. The lesions in this case of documented HSV keratitis are multiple, smaller, and with less impressive branching. However, the clinician should recognize the dendritic appearance. The overall context of the patient's clinical presentation helps to make the diagnosis (pain, photophobia, blurred vision, tearing, epithelial vessicles, decreased corneal sensation).
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.