Herpes Simplex and Herpes Zoster associated corneal ulcerations

Corneal ulcerations are the landmark of viral infections of the ocular surface. The clinical patterns of these ulcerations may vary according to the virus, the type of infection (epithelial or stromal) and the history of the patient. Dendritic ulcers are the most typical findings of Herpes Simplex Virus (HSV) infection, but may also be seen during Varicella‐Zoster Virus (VZV) infection. They share common feature such as rapid diffusion of fluorescein beneath the edges of the ulcer. Inversely, this diffusion is usually not seen in pseudo‐dentritic ulcers, which may be related to either some other infectious agents, or toxicity of eyedrops, or corneal denervation. Geographic ulceration is usually due to HSV infection mistreated with topical steroids, especially if the size of the defect is rapidly progressing. In contrast, a slowly progressing geographic ulcer, with amorphous margins, rather results from neurotrophic conditions. Finally, deep corneal ulcerations, involving both the epithelium and the stroma should be first treated as HSV or VZV necrotic keratitis, but other agents like bacteria, acanthameba and even fungi may lead to similar findings. Such cases thus need a daily control of the evolution to find optimal treatment.