Misdiagnosed Keratitis: From Antibiotics Failure To Steroid Response

To highlight a diagnostic pitfall where herpetic disciform keratitis presents as a non-healing corneal ulcer, leading to delayed appropriate management.

Private ophthalmology practice.

A patient presented with persistent corneal ulcer previously treated as bacterial keratitis with intensive topical antibiotics and no clinical improvement. Detailed slit-lamp examination demonstrated stromal edema with a central disc-shaped opacity, intact epithelium, keratic precipitates, and mild anterior chamber reaction suggestive of immune-mediated herpetic stromal keratitis.

Antibiotics were discontinued and treatment was shifted to topical corticosteroid combined with antiviral therapy.

Rapid clinical improvement occurred following therapy modification with reduction of stromal edema and restoration of corneal clarity. Visual acuity improved significantly after treatment. No surgical intervention was required.

Disciform keratitis may closely mimic bacterial keratitis and should be suspected in non-responding corneal ulcers. Careful slit-lamp evaluation allows early diagnosis and prevents unnecessary prolonged antibiotic treatment and vision-threatening stromal damage.