Bilateral Herpetic Keratitis: A Case Report

herpetic eye disease is characteristically unilateral. Simultaneous bilateral development of herpetic keratitis is very rare, representing less than 5%. It has been described in patients with atopy  and in patients with an altered immune system .

Ophtalmology B Departement , ibn sina university hospital ,Rabat,Morocco .

A 56-year-old male was referred to our department complaining of bilateral redness and severe eye pain over the  2 past weeks. His  medical history included ankylosing spondylitis, unbalanced diabete, ocular history  of herpetic keratitis with 3 recurrences treated with oral antivirals .

At presentation, his best corrected visual acuity  was light perception and 4/10 in the right and left eye, respectively. Slit-lamp examination disclosed  a total corneal opacification in the right eye , typical features of HSV keratitis including dendritic ulcer with underlying subepithelial infiltrate, corneal edema, in the left eye ,The lesions stained diffusely with fluorescein dye.

Tear samples had been taken from both eyes to perform the polymerase chain reaction and to amplify and detect HSV DNA. This examination from both eyes was positive and confirmed diagnosis of bilateral HSV keratitis.the patient was traited by topical acyclovir and systemic valacyclovir.

Improvement of epithelial corneal defects, and visual acuity of the left eye was achieved gradually during the follow-up period.A penetrating keratoplasty is planned in a second step for the right eye .

Herpes simplex virus keratitis is a leading cause of corneal opacification, and the associated visual reduction usually is the result of recurrence rather than of primary disease.it reactivation has been reported to be more frequent and often more serious in patients with systemic atopy or with altered systemic immunity.regular follow-up of these patients is essential to avoid Delays in treatment related to misdiagnosis that can lead to visually devastating corneal opacification