Which keratitis is most likely to show pseudo-dendrites on examination?

Which keratitis is most likely to show pseudo-dendrites on examination?

• A. Acanthamoeba keratitis
• B. Bacterial keratitis
• C. Viral keratitis
• D. Sterile keratitis

Answer: (A)

Pseudo-dendrites are irregular, branching epithelial defects on the corneal surface that resemble dendrites but aren’t true viral ulcers. This pattern is characteristic of Acanthamoeba keratitis. The trophozoites invade the corneal epithelium and extending nerves, creating these jagged, branching defects that can stain with fluorescein yet lack the classic, well‑defined terminal bulbs seen with true dendrites. In contrast, viral keratitis (herpes simplex) shows true dendritic ulcers that have smooth, elongated branches with distinct terminal bulbs. Bacterial keratitis tends to produce non-dendritic ulcers with suppurative infiltrates and a more focal erosion, while sterile keratitis lacks infectious epithelial patterns altogether. So the presence of irregular, pseudo-dendritic epithelial defects points to Acanthamoeba keratitis.

Pseudo-dendrites are irregular, branching epithelial defects on the corneal surface that resemble dendrites but aren’t true viral ulcers. This pattern is characteristic of Acanthamoeba keratitis. The trophozoites invade the corneal epithelium and extending nerves, creating these jagged, branching defects that can stain with fluorescein yet lack the classic, well‑defined terminal bulbs seen with true dendrites. In contrast, viral keratitis (herpes simplex) shows true dendritic ulcers that have smooth, elongated branches with distinct terminal bulbs. Bacterial keratitis tends to produce non-dendritic ulcers with suppurative infiltrates and a more focal erosion, while sterile keratitis lacks infectious epithelial patterns altogether. So the presence of irregular, pseudo-dendritic epithelial defects points to Acanthamoeba keratitis.