MANAGEMENT OF BILATERAL SUPERINFECTED MEASLES KERATITIS: A CASE REPORT

To report the case of a bilateral measles keratitis in a 10 years old girl.

Measles is an infection caused by the morbillivirus (Paramyxoviridae family). It primarily affects young children and progresses through four stages: incubation, invasion, rash, and desquamation.

Ocular manifestations can appear during the invasive and rash phases. Conjunctivitis is the most common ocular finding and is often asymptomatic.

Measles keratitis is the most serious ocular complication, with potential outcomes including corneal ulcers, bacterial superinfection, and even corneal perforation, especially in cases of vitamin A deficiency or immunosuppression.

We describe the clinical presentation, management, and outcome of bilateral measles keratitis complicated by superinfection in a 10-year-old girl during a measles outbreak in Morocco in 2025.

A previously healthy 10-year-old girl presented with a generalized maculopapular rash, fever, eye redness, foreign body sensation, photophobia, and tearing. In the context of an epidemic, measles with conjunctivitis was diagnosed, and symptomatic inpatient treatment was initiated.

After improvement of cutaneous symptoms, she was discharged for outpatient care but self-administered topical corticosteroids due to persistent ocular discomfort, worsening her condition and prompting re-presentation to ophthalmology.

Examination revealed severely reduced visual acuity (counting fingers in OD, 1/10 in OS), purulent discharge, conjunctival hyperemia, and bilateral central corneal infiltrates (OD 4 × 4 mm, OS 3 × 2.9 mm) with ulcers, satellite infiltrates, and neovascularization, consistent with a superinfected measles keratitis.

The patient received fortified eye drops (vancomycin 50 mg/ml, ceftazidime 20 mg/ml, amphotericin B 1.5 mg/ml), underwent amniotic membrane transplantation and PACK cross-linking. After infection control, topical corticosteroids were cautiously introduced, and topical insulin was applied to the left eye for a persistent ulcer.

Her clinical course showed marked resolution of infiltrates and healing of ulcers, with visual acuity improving to 9/10 in OD and 5/10 in OS.

Ophthalmic manifestations of measles primarily affect the conjunctiva and cornea.

Serious complications, including corneal superinfection and perforation, are more likely in patients with xerophthalmia, immunosuppression, or corticosteroid misuse.

These complications are common in regions with interrupted vaccination programs or in densely populated areas.

Management of uncomplicated cases is symptomatic, and complete recovery is generally expected.