A specific clinical diagnosis of HSV as the cause of dendritic keratitis can usually be made by ophthalmologists and optometrists based on the presence of characteristic clinical features.
Diagnostic testing is seldom needed because of its classic clinical features and is not useful in stromal keratitis as there is usually no live virus.
Laboratory tests are indicated in complicated cases when the clinical diagnosis is uncertain and in all cases of suspected neonatal herpes infection:
Corneal smears or impression cytology specimens can be analyzed by culture, antigen detection, or fluorescent antibody testing.
Tzanck smear, i.e.
Papanicolaou staining of corneal smears, show multinucleated giant cells and intranuclear inclusion bodies, however, the test is low in sensitivity and specificity.

DNA testing is rapid, sensitive and specific.
However, its high cost limits its use to research centers.

Demonstration of HSV is possible with viral culture.

Serologic tests may show a rising antibody titer during primary infection but are of no diagnostic assistance during recurrent episodes.
A specific clinical diagnosis of HSV as the cause of dendritic keratitis can usually be made by ophthalmologists and optometrists based on the presence of characteristic clinical features. Diagnostic testing is seldom needed because of its classic clinical features and is not useful in stromal keratitis as there is usually no live virus. Laboratory tests are indicated in complicated cases when the clinical diagnosis is uncertain and in all cases of suspected neonatal herpes infection:
Corneal smears or impression cytology specimens can be analyzed by culture, antigen detection, or fluorescent antibody testing. Tzanck smear, i.e.Papanicolaou staining of corneal smears, show multinucleated giant cells and intranuclear inclusion bodies, however, the test is low in sensitivity and specificity.
DNA testing is rapid, sensitive and specific. However, its high cost limits its use to research centers.
Demonstration of HSV is possible with viral culture.
Serologic tests may show a rising antibody titer during primary infection but are of no diagnostic assistance during recurrent episodes.
Herpes simplex keratitis