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Chronic immunosuppressive therapy and bilateral ocular infection: a causal relationship

Poster Details

First Author: E.Kanonidou GREECE

Co Author(s):    C. Kanonidou   I. Zampros   N. Lakidis   V. Konidaris   T. Lalias   G. Sakkias

Abstract Details


Herpes simplex keratitis is, in general, a unilateral disease, but bilateral occurrence has been reported in 1.3% to 10.9% of patients. Bilateral herpetic keratitis is known to develop in patients with compromised immune system, such as those with congenital immune deficiencies, atopy, recipients of organ transplants or on immunosuppressant therapy. We report a case of a patient with Subcorneal Pustular Dermatosis (Sneddon and Wilkinson syndrome) who developed bilateral herpetic keratitis related to lond –term immunosuppresion.


Department of Ophthalmology, ‘’Hippokrateion’’ General Hospital of Thessaloniki, Thessaloniki, Greece.


A 78 year old female patient was admitted to the Department of Dermatology for the investigation of skin lesions, resulting in the diagnosis of Subcorneal Pustular Dermatosis (Sneddon and Wilkinson syndrome) and treatment with dapsone. She developed haemolysis as a side effect of the above medication and she was started on corticosteroids. After 3 weeks of the initiation of corticosteroid treatment, the patient complained of blurred vision, pain, foreign body sensation, tearing and redness in both eyes and an ophthalmological evaluation was requested.


The slit lamp examination revealed characteristic dendritic corneal ulcers in both eyes, which were suggestive of HSV keratitis. They were associated with reduced corneal sensation. The patient was treated with antiviral agents (acyclovir 3% ointment five times daily) and lubricants with a good outcome.


Patients with systemic diseases on long-term corticosteroid treatment are immunosuppressed. Therefore, they are at high risk for reactivation of latent HSV infections. Although herpetic keratitis involving both eyes is rare, it is more often seen in patients who are immunocompromised. These patients should receive regular and thorough ocular examinations aiming for an early diagnosis and treatment of this condition.

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