Atypical Presentation of Herpes Stromal Keratitis in a Contact Lens Wearer

Abstract

This article describes the case of a 21-year-old female habitual contact lens wearer who complained of left eye pain, redness, and decreased vision for one week. When a ring-shaped corneal infiltration indicative of an Acanthamoeba infection was discovered, standard anti-amoebic topical therapy with polyhexamethylene biguanide and chlorhexidine was commenced. However, her keratitis worsened. At the same time, corneal scraping revealed no pathogens. An anterior chamber examination revealed a loss of corneal sensation, and a positive herpes simplex virus (HSV) immunoglobulin G serology test indicated HSV keratitis. She was eventually treated with oral anti-viral medication and recovered completely. Her case was unusual, as she had a history of contact lens use, painful corneal ulceration, and the development of Acanthamoeba keratitis-like corneal ring infiltration. This case also reinforces the various manifestations of HSV keratitis, which lead to delayed diagnosis and treatment.

Herpes simplex keratitis: A brief clinical overview

“…Contact lenses have been implicated in infectious processes[ 393 ]. Subramaniam et al [ 394 ] detailed a case report of HSK in a contact lens wearer that completely resolved on oral antiviral therapy of 800 mg of Acyclovir five times daily alone[ 394 ]. However, it should be noted that Acanthamoeba is more likely to cause keratitis in contact lens wearers than HSV[ 395 - 397 ].…”