As a young ophthalmologist, I found corneal epithelial diseases a subject diffcult to grasp. One day, it occurred to me that the reason might be a lack of images showing the nature of the components of the changes visible with the slit lamp. With the slit lamp, the inevitable eye movements that blur the image limited the magnifcation level, but perhaps photography might be the answer. It was not a short journey, but in the end the idea proved right. By trial and error, the quality of the images improved, and after some time, I found that the resolution allowed reasonable comparisons with available images of histological preparations. Such comparisons allowed better und- standing of the substructures of epithelial in vivo lesions and, in conjunction with their in vivo dynamic features, eventually an understanding of at least some mechanisms behind them. This book, originating from over 20 years of experience with observations of ocular surface changes at high magnifcation level, covers several aspects of corneal epithelial lesions caused in humans by herpes simplex virus: various shapes of the lesions, their substructure and mechanisms behind them; morphological features of the healing p- cess, sequelae, complications, and some accompanying signs; and some rare cases. For those less familiar with the slit lamp image, I have added explanatory drawings to facilitate comprehension.

Preface

About Epithelial Keratitis
About Herpes Simplex Virus (HSV) Epithelial Keratitis
The Morphology of Herpes Simplex Virus Epithelial Keratitis
HSV Cytopathic Effect - Early Changes
HSV Cytopathic Effect - Advanced Changes
Early HSV in Vivo Lesions - Surface Elevation and Disruption
An Advanced HSV in Vivo Lesion - Loss of Substance
HSV Lesions - Surface Elevation, Depression, and Fluid Diffusion
Rose Bengal Dye Staining of HSV Lesions
A HSV Dendritic Figure (1)
A HSV Dendritic Figure (2)
The Origin of HSV Dendritic Figures
Various Shapes of HSV Dendritic Figures
Some Other Shapes of HSV Lesions
Precursors of HSV Geographic Lesions
HSV Geographic Lesions
A Case of Primary HSV Keratitis.-Healing of Herpes Simplex Virus Epithelial Keratitis Treated with Acyclovir Ointment, and Short-term Sequelae of the Infection
Healing of HSV Epithelial Keratitis with Acyclovir Ointment
Healing of HSV Epithelial Keratitis with Acyclovir Ointment. A treatment failure
Side Effects of Acyclovir Ointment
Complications, Accompanying Signs, Recurrences, and Long-term Sequelae of Herpes Simplex.-Virus Epithelial Keratitis
Case 1. HSV Epithelial Keratitis - a Fresh and an Older Lesion
Healing Followed by Epithelial Breakdown, and a New Repair (Case 1, cont.)
Case 2. Healing of HSV Epithelial Keratitis, Accompanying Signs, and Sequelae
Case 3. HSV Epithelial Keratitis and Stromal Infiltrates
Case 4. HSV Epithelial Keratitis Preceded by Anterior Uveitis and Disciform Keratitis
HSV Epithelial Keratitis and Dry Eye (Case 4, cont.)
Case 5. Recurrent HSV Epithelial Keratitis in a Patient with Dry Eye.-Bibliography
Index