Dendritic ulcers on the cornea are a hallmark of which keratitis?

• A. Fungal keratitis
• B. Bacterial keratitis
• C. Acanthamoeba keratitis
• D. Herpes simplex keratitis

Answer: (D)

Dendritic ulcers are a classic sign of herpes simplex keratitis, caused by herpes simplex virus type 1 infecting the corneal epithelium. When the cornea is stained with fluorescein and viewed under blue light, active HSV epithelial lesions form branching, serpiginous ulcers with distinct terminal bulbs—shaped like tree branches. This branching pattern is highly characteristic of HSV involvement and helps distinguish it from other keratitides.

In contrast, bacterial keratitis typically presents with a more rounded ulcer, rapid progression, and purulent discharge; fungal keratitis often shows feathery margins with possible satellite lesions; acanthamoeba keratitis can produce ring-shaped stromal infiltrates and severe pain out of proportion to exam. So the dendritic pattern specifically points to herpes simplex keratitis.