Abstract
Abstract: :
Purpose:To describe the importance of detailed systematic approach in managing a patient with persistent keratopathy of unknown etiology. Methods:The patient underwent complete reviews of system, ophthalmic and medical examinations, and was treated with appropriate therapy. Results:A 73–year old man was referred for redness in the left eye of two–week duration. The vision in this eye has been very poor (HM) for about thirty years. On examination, the right eye was within normal limits. In the left eye, there was significant peri–limbal congestion. The left cornea was edematous and opaque in the center without epithelial fluorescein staining. The intraocular pressure (IOP) was in the mid 30’s. The patient was started on acetazolamide and topical antihypertensive agents. During follow–up examination, it was noted that the corneal sensation was markedly absent in the left eye. Further questioning revealed remote past history of zoster ophthalmicus. Thus, in addition to the anti–hypertensive therapy, the patient was started on topical fluorometholone (FML) and acyclovir 800 mg per day; however, he developed a painless dendritic ulcer in the left eye. FML was discontinued and topical trifluridine (Viroptic) was started at 5 times daily. The corneal ulcer quickly responded to treatment and healed. Since there was persistent stromal keratitis, FML was restarted at three–time–daily dosing, in conjunction with trifluridine and oral acyclovir 800 mg per day. The stromal keratitis responded to treatment and the vision improved to 20/60. The IOP remained under control with topical anti–hypertensive therapy. Conclusions:Herpetic keratitis should always be considered in chronic keratitis of unknown etiology, especially in the presence of ocular hypertension. Careful review of systems and examination, and proper management may help to restore vision in patients with chronic visual morbidity.
Keywords: cornea: clinical science • inflammation • herpes simplex virus