Bilateral Peripheral Ulcerative Keratitis Post Herpes Simplex Keratitis (A Rare Case Report)

Purpose: To report a rare case of bilateral Peripheral ulcerative keratitis post herpes simplex keratits

A 19 year old female presented to our center with pain, redness, watering and diminution of vision in left eye since 4 days. No known systemic illness. Slit lamp bio-microscopy revealed perforated PUK along with crescentic corneal thinning in left eye and conjunctival congestion. Patient’s right eye also had supero-nasal thinned out cornea. A provisional diagnosis of bilateral PUK (peripheral ulcerative keratitis) with perforated left eye PUK was made.A battery of tests for autoimmune association of PUK was ordered, which came out to be negative, ruling out any systemic autoimmune association of PUK. Herpes simplex virus (HSV) antigen was identified on tear polymerase chain reaction (PCR). Patient was started on topical antibiotics and cycloplegics, as well as systemic acyclovir. The management included urgent surgical intervention in left eye, in form of a patch graft along with amniotic membrane graft (AMG) and conjunctival recession away from limbus. A multilayered AMG was performed in right eye. Improvement was noted in patient status post keratoplasty in left eye and post multilayered AMG in right eye in terms of visual acuity, globe integrity and decreased inflammation of conjunctiva

Both autoimmune and infectious causes to be kept in mind while handling a case of PUK. Herpetic eye disease can present as PUK bilaterally and can have devastating complications (corneal perforation) as in our case. A keen eye and broad differentials to be kept in mind while working up a patient of PUK. It is important to rule out infectious etiology for early and satisfactory management.