Diagnostic Considerations
Corneal epithelial changes characterized by a branching pattern are referred to as dendriform or dendritic keratopathy. The foremost entity that causes such a branching pattern is herpes simplex dendritic keratitis. Few other conditions create this pattern, but they should be considered in the differential diagnosis of healing epithelial abrasions. These conditions include dendritic plaques in herpes zoster ophthalmicus and the rare condition of dendriform keratopathy in tyrosinemia.
In addition to creating complex dendritic and vortex patterns, healing corneal abrasions may have a simple linear pattern at the forefront of epithelial migration. Such lines are easy to diagnose on the basis of the history and their rapid evolution.
Diabetes affects the cornea by interfering with the hemidesmosomes that anchor the epithelium to its basement membrane. The number of hemidesmosomes in people with diabetes is markedly reduced, a phenomenon that may be due to altered extracellular matrix. As a consequence of this reduction, the epithelium is removed relatively easily, and minimal trauma can lead to corneal abrasions.
Moreover, reepithelialization takes longer in people with diabetes, and these patients may develop recurrent erosion syndrome. This is a particular problem in patients undergoing vitrectomy, because the entire epithelium may be intentionally removed during surgery for the purpose of visualization, with delay of corneal healing.
Differential Diagnoses
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This corneal abrasion appears as a yellow-green area when stained with fluorescein and viewed with a blue light.
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Corneal abrasion.
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Large corneal abrasion.
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Corneal keratitis and staining.
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Corneal foreign body.
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Corneal foreign body after removal.
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Corneal foreign body with cobalt blue lighting showing abrasion.
