Recurrent anterior uveitis accompanied by coin-shaped endothelial lesions that looked like scars!
HZO (Herpes Zoster ophthalmicus) causes repopulation and reactivation of VZV (varicella-zoster virus) throughout the ophthalmic branch of the trigeminal nerve. Once the nasociliary nerve is invaded by VZV, multiple eye tissues are affected. For example, the conjunctiva, sclera, cornea, iris, optic nerve, choroid, and retina. They all become inflamed.
Moreover, 65-67% of patients suffer from corneal complications and based on the frequency order, they consist of “punctate epithelial keratitis, pseudo-dendritic keratitis, anterior stromal keratitis, keratouveitis, neurotrophic keratitis, and disciform stromal keratitis”. Furthermore, although these corneal complications have a transient course, some of the cases can progress to a chronic form. For example, neovascularized lipid keratopathy especially in disciform stromal keratitis and nummular anterior stromal keratitis.
This case report is of a coin-shaped corneal endothelial scar in herpes zoster virus, which mimicked cytomegalovirus-induced coin-shaped corneal endotheliitis. Moreover, it was remitted by a combination of low-dose oral acyclovir and topical ganciclovir gel therapy.
Case Presentation
A 39-year-old Asian female was referred to the ophthalmology department because she had recurrent anterior uveitis. In addition, it was accompanied by coin-shaped endothelial lesions that looked like scars. They appeared after facial herpes zoster. Moreover, diffuse corneal stromal haziness was limited to the anterior stroma mostly.
The coin-shaped corneal endothelial lesions were different from stromal lesions, showing the highly reflective scars-like lines in sections of anterior segment optical coherence tomography.
Whenever the patient discontinued taking the oral antiviral drugs, her anterior uveitis recurred. This happened for the first twelve months after the first event. However, it was remitted through maintenance medications of topical ganciclovir gel and oral valaciclovir. It was given at a dose, which was less than the usual adult dose for acute zoster-associated anterior uveitis. Furthermore, the corneal endothelial function was normal, and no change was seen in the corneal endothelial and stromal lesions throughout the follow-up.
