Game 3
Solve
in
1
An old man walks in. Maybe like his 70s.
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He has a very normal looking adnexa, yet he appears to be in pain.
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He puts on a slightly disgruntled face, and his right ear sort of looks like its bulging.
Solve
in
2
"It keeps on happening doc."
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You reassure him, and you observe his eye under a slitlamp. You see a bunch of white dots.
Endothelium cells??
No wait, your slitlamp isn't focused that far back.
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Indirect retro reveals what looks like cracks. You stain for a better view
Solve
in
3
The cornea looks like a cracked glass under fluorescin. Almost as if someone struck your window with a rock.
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He feels uncomfortable and rubs his eyes. You advise him not to do that. Is his sclera black??
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You ask him to look peripherally.
Last
chance
Yeah ok. The sclera is a bit dark.
Looking into the anterior chamber, you see things floating around.
"they keep popping up."
It seems like he can see them too
​
Ok, you give him the diagnosis, but you also give him an oral cover and some corticosteroids and tell him to be safe.
The answer
Herpes Zoster Keratitis
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- The zoster sine herpete is a feature of Zoster, in which no skin rash or shingles appear
- Preauricular lymphadenopathy may occur, or swelling
- Cells may appear in AC, causing flare.
- Satellite lesions have no terminal bulbs unlike HSV
- Nummular keratitis precipitates may occur just beneath Bowman's layer
- Scleral atrophy may be present.
- No steroids for viral epithelial disease, always an oral cover with corticosteroids