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Pseudodendrites are frequently mistaken for herpes simplex dendrites. It is this similarity that will create anxious moments about the diagnosis and plan of action. However, there are some important things to keep in mind that should help separate out the likely culprit and push forth a solid clinical treatment plan.
Pathophysiology
Pseudodendrites are epithelial-based lesions that present as interconnected creases covering a small area of the corneal surface. Exposed epithelial cells appear to heap on top of each other and create linear interconnections. While the lesion might look very much like a classic herpes simplex virus (HSV) dendrite, a pseudodendrite is more linear with a horizontal "Y" or double-ended "Y"1 and does not have the classic bulbous ends that are often encountered with herpetic lesions. Additionally, there are rarely more than 2 branches off the same trunk2 and the overlying epithelium is often times granular appearing and heaped up, not absent as is the case with herpetic lesions.
Pseudodendrites are associated with a variety of clinical cases, including contact lens wear,3...