Posters

The role of fluorescein filter imaging to aid the diagnosis of corneal dendritic lesions

Poster Details

First Author: K. Pawlowicz UNITED KINGDOM

Co Author(s):    A. Sharma   G. Saleh   G. Nithyanandarajah   K. Emeriewen   M. Arjunan   S. Balal     

Abstract Details

Purpose:

There are many causes of dendritiform lesions, from the classic herpes simplex keratitis dendrites to pseudodendrites of healing epithelial defects. The aim of this study was to assess fluorescein staining of the cornea through Fluorouscein Filter Imaging. Correct clinical diagnosis is imperative to initiate a management plan, particularly in situations where there is a delay in investigations or recurrent negative results. Fluorescein Filter Imaging would aid early clinical diagnosis and therefore facilitate the most appropriate and effective treatment.

Setting:

The pictures were taken at Moorfields Ophthalmology Department at Bedford, NHS Foundation Trust Hospital.

Methods:

Fluorescein filters using a fundus fluorescein camera were used to image fluorescein stained corneas affected with Herpes Zoster. The camera used was a digital fundus camera with standard exciter and barrier fluorescein filters. Pictures were obtained after application of a single drop of 1% sterile unpreserved fluorescein sodium solution, applied to the inferior conjunctival fornix. We compared the images to the clinical presentation of the patient. By adjusting the magnification, the enhanced resolution fluorescein filter images allowed a high contrast detailed analysis of the architecture of the dendrites.

Results:

The images demonstrate the structural differences visible between Herpes simplex (HSV) and Herpes Zoster dendrites (HZV). In contrast to HZV dendrites, in HSV dendrites the pathognomonic terminal bulbs and dichotomous branches are clearly visible (Figures 2 and 1). The results obtained were superior to comparable outcomes using simple examination and blue light photography. Residual stromal scarring, also known as Ghost dendrites, can remain after resolution of HSV epithelial keratitis (Figure 3). Fluorescein Filter Imaging allows for a better diagnosis of Thygesons keratitis and can also aid in the follow up of lesions (Figures 4 and 5).

Conclusions:

Fluorescein Filter Imaging is a valuable tool to better image, document corneal epithelial pseudodendrites and to differentiate them from true dendritic keratitis. This technique is safe for patients, easy to access, reliable and effective to diagnose and manage dendritiform corneal disease. In addition, Fluorescein Filter Imaging might be considered in teleophthalmology to remotely evaluate anterior surface of cornea.

Financial Disclosure:

NONE