ESCRS - PO704 - Herpetic Necrotizing Keratitis Following Covid-19 Infection

Herpetic Necrotizing Keratitis Following Covid-19 Infection

Published 2024 - 42nd Congress of the ESCRS

Reference: PO704 | Type: Poster | DOI: 10.82333/d92f-6n60

Authors: Francesc March De Ribot* 1 , Emma Jane 2 , Anna March de Ribot 1

1University hospital,Girona,Spain, 2University hospital,Dunedin,New Zealand

Purpose

Herpetic necrotizing keratitis is a severe ocular manifestation of herpes simplex virus (HSV) infection, characterized by corneal inflammation and necrosis. It is characterized by corneal stromal necrosis, often leading to significant visual impairment. Predisposing factors include a history of herpetic infections, corneal trauma, and immunocompromised states. 

Setting

University hospital

 

Methods

Clinical Case Description: A 65-year-old woman with a history of left eye herpetic infection in the 1990s. The patient experienced irritation and decreased vision in the left eye two weeks after recovering from COVID-19; for this, she tested positive after a limited episode of fever and cough. She had 4 vaccinations against COVID-19; the most recent one was 15 months prior to this presentation. The visual acuity was 6/18 in the left eye; intraocular pressure was within normal limits. The ocular examination revealed conjunctival hyperemia with stromal necrosis in the superonasal cornea in the left eye with an adjacent paralimbic area of involvement measuring 1.5mm, with pannus and positive fluorescein staining. 

Results

 
A clinical diagnosis of herpetic necrotizing keratitis was made for her left eye after COVID-19. The initial management included topical antivirals (Aciclovir ointment 3%, five times daily), systemic antivirals (PO Aciclovir 200mg, five times daily) and systemic steroids (PO prednisone 60mg). In the follow-up, the situation was resolved.  
Discussion: Herpetic necrotizing keratitis after COVID-19 is unprecedented and warrants further investigation into potential associations. Many ocular associations with COVID-19 active infection have been reported in the last 3 years, conjunctivitis, keratitis, scleritis, acute anterior uveitis, optic neuritis and retinovascular disease. 

Conclusions

This case of herpetic necrotizing keratitis following COVID-19 infection, emphasizing the importance of recognizing and managing ocular complications in individuals with a history of herpetic infections. Further research is needed to understand the pathophysiology and implications of ocular manifestations post-COVID-19.