# Bilateral Multiple Herpetic Epithelial Keratitis: A Case Report and Review of the Literature

## TL;DR

This paper reports a rare case of bilateral herpetic epithelial keratitis in a 13-year-old child and discusses its diagnosis and treatment.

## Contribution

The paper contributes a rare clinical case of bilateral herpetic epithelial keratitis and emphasizes the importance of early diagnosis and treatment.

## Key findings

- Bilateral herpetic epithelial keratitis is a rare manifestation of HSV infection.
- Diagnosis relies on clinical findings such as bilateral dendritic ulcers and fluorescein staining.
- Management involves antiviral therapy and close follow-up for optimal outcomes.

## Abstract

Herpetic epithelial keratitis is a viral infection of the cornea caused by the herpes simplex virus (HSV). It typically presents as a unilateral disease. Bilateral involvement is a rare manifestation of herpetic epithelial keratitis, accounting for only a small percentage of cases. By sharing this case, we aim to contribute to the understanding of bilateral herpetic epithelial keratitis and stimulate further research in this area to optimize patient care and outcomes

A 13-year-old child, a known case of atopy, presented to the ophthalmology clinic with a complaint of pain, photophobia, and redness in the right eye (OD) for three days. The patient was diagnosed as a case of bilateral herpetic epithelial keratitis; he was started on moxifloxacin eye drops four times a day, Artelac (sodium hyaluronate) every two hours, carbomer HS, ganciclovir ointment five times per day.

Bilateral herpetic epithelial keratitis is a rare manifestation of HSV infection, and its management poses unique challenges compared to unilateral disease.

The diagnosis of bilateral herpetic epithelial keratitis is primarily based on clinical findings, including bilateral dendritic or geographic ulcers on the cornea. Fluorescein staining is a valuable tool for visualizing corneal ulcers. In our case, the presence of bilateral dendritic ulcers in the absence of significant anterior chamber inflammation supported the diagnosis of bilateral herpetic epithelial keratitis

Despite the limited literature on bilateral herpetic epithelial keratitis, the principles of management remain consistent with those of unilateral disease. Early recognition, prompt initiation of antiviral therapy, and close follow-up are crucial for successful outcomes.