Case 3. HSV Epithelial Keratitis and Stromal Infiltrates

Case 3. HSV Epithelial Keratitis and Stromal Infiltrates

Case Report

Six years before these photographs were taken, this 45-year-old woman with no history of eye disease presented with redness, irritation, photophobia, and pain in the right eye. The symptoms started 3 days previously. The cornea showed two whitish and partly ulcerated infiltrates at 8 and 11 o’clock, close to the limbus. She was treated with topical antibiotics and cortisone. The infiltrates resolved within 8 days.

Six years later, the right eye became inflamed again. At presentation, the duration of symptoms was 10 days. The cornea showed two whitish infiltrates located at 5 and 11 o’clock close to the limbus, accompanied by a small HSV-suspect epithelial lesion. On questioning, the patient reported that she had been suffering from blisters in her mouth for many years, and that the latest attack had occurred 2 weeks previously. She was treated with acyclovir ointment five times a day. Five days later, all signs of active epithelial infection were gone, and the infiltrates were smaller. After a further week of treatment, all inflammatory signs were gone. Virus isolation test in cell culture revealed HSV type 1 (HSV-1).

Fig. 3.21  Left:An infiltrate (black arrow) and an epithelial lesion (white arrow).

Right: Both partly stain green with fluorescein sodium

area of observation