External Diseases

Debridement may be a useful adjunct to antiviral therapy for the treatment of herpes simplex dendritic keratitis. Impression debridement may be superior to presently accepted forms of mechanical debridement including blunt spatula and minimal wiping since it avoids damage to the basement membrane, avoids spread of infectious viral particles, and allows the immediate initiation of antiviral therapy. Impression debridement is performed by application of cellulose acetate filter paper to the dendrite. Infected cells adhere to the filter paper and are lifted off while uninfected epithelial cells remain on the corneal surface. Patient discomfort is minimal avoiding the need for patching. Impression debridement was applied to dendritic lesions produced in six BALB/c mice and to the corneas of four normal BALB/c mice. Immunoperoxidase histochemical staining techniques readily demonstrated herpes simplex virus (HSV) antigen-bearing cells adherent to the filter paper in all six infected mice. The four controls showed no staining. Five patients with herpes simplex dendritic keratitis were treated with impression debridement combined with trifluorothymidine therapy. Complete epithelial healing occurred in all five cases within four days without observed recurrences.