Ulcera corneal traumática y herpética

A 47-year-old patient came to the clinic on February 11, 2021 because two days earlier he had poked his finger in his left eye, causing a wound and losing vision. He had severe pain, epiphora, a foreign body sensation, and mild photophobia. His corrected vision was unidirectional in the right eye and 1/3 in the left eye. A traumatic corneal ulcer was observed in the left inferior nasal quadrant. I prescribed diclofenac eye drops, Tobrex ointment, and Gelocatil or another oral analgesic, depending on the pain. Two days later, the ulcer had shrunk by half. Five days later (February 18, 2021), he presented with a foreign body sensation, epiphora, less pain, but very intense photophobia. He stated that he was constantly in a dark room at home. The cornea was hypoesthetic when touched with a hemostat. The initial corneal ulcer was almost healed, but two new ulcers had appeared: one elongated in the lower temporal region and a smaller one in the temporal part of the pupillary area. Less pain than expected and such intense photophobia led me to suspect superficial herpetic keratitis. Upon examination with fluorescein, both new ulcers showed significant uptake of the dye. The lower temporal ulcer was elongated with bulbous ends. It was therefore herpetic dendritic keratitis, which I treated with ganciclovir ointment five times a day. The ulcers disappeared within a week. COMMENT I find this case very interesting for differentiating the key symptoms of traumatic ulcers from herpetic ulcers. Both traumatic and herpetic corneal ulcers present similar symptoms: tearing, pain, photophobia, and a foreign body sensation that worsens in light, blinking, and rubbing the eyelids. In traumatic corneal ulcers or erosions, the nerve endings are active, which is why the patient presented intense pain but with mild or moderate photophobia. In contrast, in herpetic corneal ulcers, the free pain endings are altered, and the cornea becomes hypoesthetic, but they cause very intense photophobia. Topical nonsteroidal anti-inflammatory drugs such as diclofenac (Voltaren) and ketorolac (Acular) are somewhat useful for reducing pain in corneal erosions. Remember: traumatic erosions are very painful with mild or moderate photophobia. They are relieved with anesthetic drops. In contrast, in herpetic keratitis, there is little pain, but the photophobia is very intense. They improve when the light is turned off. Bonafonte Ophthalmology Center Eye Surgery and Diseases Pasaje Méndez Vigo 6, 08009 Barcelona. Spain Tel: + (34) 934 870 015 Visit our website: www.centrodeoftalmologiabonafonte.com Email: [email protected] Instagram:   / centrodeoftalmologiabonafonte   Facebook:   / centrodeoftalmologiabonafonte