Epstein-Barr Virus-Associated Interstitial Keratitis With Corneal Stromal Ring: A Case Report
Published 2025 - 43rd Congress of the ESCRS
Reference: PO121 | Type: Case Report | DOI: 10.82333/4bmn-4904
Authors: Lars Christian Boberg-Ans* 1 , Ayyad Zartasht Khan 2 , Andreas Arnold-Vangsted 3 , Marius Birkeland Mo 4 , Frederik Ersø Philipsen 5 , Karim Amini 6
1Ophthalmology,University Hospital of Southern Denmark,Vejle,Denmark;Ophthalmology,Innlandet Hospital Trust,Elverum,Norway, 2Ophthalmology,Haukeland University Hospital,Bergen,Norway;Ophthalmology,Oslo University Hospital,Oslo,Norway;Ophthalmology,Sørlandet Hospital Arendal,Arendal,Norway, 3Ophthalmology,University Hospital of Southern Denmark,Vejle,Denmark, 4Ophthalmology,Nordland Hospital Trust,Bodø,Norway, 5Ophthalmology,Euroeyes,Copenhagen,Denmark, 6Ophthalmology,Nordland Hospital Trust,Bodø,Denmark
Purpose
To present a rare case of Epstein-Barr virus (EBV)-induced interstitial keratitis with a corneal stromal ring in a young patient, highlighting the clinical course, diagnostic challenges, and therapeutic approach.
Setting
Department of Ophthalmology, Innlandet Hospital Trust, Norway.
Report of case
A 19-year-old male presented with recurrent episodes of hypertensive keratouveitis in the left eye. Despite the usual virologic and immunologic workup, no specific microorganisms were identified. Polymerase chain reaction (PCR) tests for herpes simplex viruses (HSV) 1 and 2, and varicella-zoster virus (VZV) were negative. The patient was managed with topical dexamethason and valaciclovir, along with dorzolamid and timolol. Three months after the last episode, the patient developed a ring-shaped corneal stromal haze with mild anterior chamber reaction. Upon direct questioning, the patient disclosed a history of mononucleosis six months earlier. Further serological testing showed elevated EBV IgG, indicating a post-viral immune-mediated response. The patient was prescribed oral valacyclovir, topical dexamethasone, dorzolamide and timolol. The corneal stromal ring gradually resolved and the the treatment regiment was gradually tapered over several months.
The patient demonstrated significant clinical improvement with resolution of the stromal haze and normalization of IOP by May 2024. Visual acuity remained stable at 1.25 Snellen OU.
Conclusion/Take home message
This case underscores the importance of considering EBV in the differential diagnosis of recurrent keratouveitis with interstitial keratitis, as it may be underdiagnosed. The presence of a corneal stromal ring in EBV-associated keratitis has been documented in a limited number of cases. The therapeutic approach with valacyclovir and corticosteroids appears beneficial in preventing stromal scarring.