How is herpes simplex keratitis in HIV infection diagnosed?

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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The diagnosis of HSV keratitis is primarily clinical, and the use of fluorescein and rose bengal dyes will highlught the characteristic corneal dendrites with terminal bulbs. Laboratory studies, including virus culture, direct fluorescent antibody tests for HSV antigens, and polymerase chain reaction (PCR) testing for HSV DNA, can help to confirm the diagnosis. In cases of interstitial keratitis, other etiologies such as syphilis, tuberculosis, and Lyme disease should be ruled out. When managing nectrotizing keratitis, bacterial, fungal, and protozoal etiology should be ruled out. The presence of the typical dermatomal rash and the clinical differentiation of pseudodendrites from dendrites can aid in the differentiation of VZV keratitis from HSV keratitis. However, the two etiologies are often difficult to distinguish when corneal involvement extends beyong the epithelium. Aqueous humor PCR can aid in differentiation of etiology in cases with concurrent iridocyclitis.

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