Dr. med. Philipp Franko Zeitz
Dr. med. Joachim Zeitz


Blumenstrasse 11-15
40212 Düsseldorf

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

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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?

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