In a case of suspected herpes keratitis, what is the most appropriate next step?

In cases of suspected herpes keratitis, referral to an ophthalmologist is the most appropriate next step. Herpes keratitis is a viral infection of the cornea caused by the herpes simplex virus, and it can lead to serious complications if not addressed promptly and appropriately. An ophthalmologist has the specialized training and tools necessary to confirm the diagnosis and initiate treatment, which may include antiviral medications.

Earlier interventions, such as a KOH prep or bacterial culture, are not suitable in this situation. A KOH prep is primarily used for identifying fungal infections, and a culture for bacteria would typically be relevant if a bacterial infection is suspected, but not necessary for confirming herpes keratitis. The application of corticosteroids can be detrimental in viral infections, as they may exacerbate the condition by allowing the virus to replicate more freely. Therefore, immediate referral ensures that the patient receives the proper care for a potentially vision-threatening condition.