Case 3 presentation

contributed by

PD Dr. Tobias Stupp, Meerbusch, Germany and Dr. Philipp Franko Zeitz, Düsseldorf, Germany

Categories: Cornea, infections, herpetic disease, surface disorders

Key problem: Multiple different findings that need treatment, but the therapy for one will worsen the other


In contrast to other case reports that You might know, we want to present expert-level cases that do not have a clear and proper solution. We do this because we believe that a case report with just one specific solution will only add more encyclopedic knowledge to Your repertoire, while an open-ended case report with a discussion will train Your methods.

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Female, 65 years old

History of metastasized ovarian carcinoma with recent chemotherapy (gemcitabine, carboplatin, bevacizumab, premedication: ondansetron, aprepitant, ranitidine, dexamethasone) 



First examination (day 1) 

Anterior segment: OS herpetic keratitis with multiple dendritis ulcerations (see photo), otherwise within normal limits

Therapy: Aciclovir ointment five times a day





Second examination (4th week)

Anterior segment: OS good improvement of the herpetic alterations with no more dendritic ulcerations visible, but now remarkable inhomogenous opacities in the upper cornea with dotted fluoresceine staining and a demarcation line with fluoresceine pooling at the inferior edge (see photo)

Therapy:  Aciclovir stopped, artificial tears every two hours





Third examination (12th week)

Anterior segment: OS unchanged on fluoresceine staining, but now progressive corneal vascularization (see photo)




How would You proceed at this point?

Send Your opinion!

This case is "open" - see others´opinions (currently 4 opinions)!