Case Report: Conservative management of herpes simplex keratitis with corneal perforation and anterior chamber collapse

TL;DR

A 54-year-old man with severe eye infection and corneal damage was successfully treated without surgery using antiviral and steroid medications.

Contribution

Demonstrates successful non-surgical treatment of herpes simplex keratitis with corneal perforation and anterior chamber collapse.

Findings

PCR confirmed herpes simplex virus as the cause of the corneal infection.

Conservative treatment with valacyclovir, ofloxacin, and fluorometholone led to full recovery without surgery.

Visual acuity improved from counting fingers to 20/30 within a month.

Abstract

This study aims to report the successful conservative management of herpes simplex keratitis (HSK) complicated by corneal perforation and anterior chamber collapse, emphasizing the importance of accurate diagnosis and close clinical monitoring to avoid surgical intervention.

A 54-year-old male patient with recurrent redness and pain in the left eye was referred for potential surgical intervention due to corneal perforation and anterior chamber collapse. Examination revealed central corneal infiltrates, a positive Seidel test, and anterior chamber collapse. A tear specimen was collected for polymerase chain reaction (PCR) testing to detect viruses, including herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), human adenovirus (HAdV), and Epstein–Barr virus (EBV).

PCR testing confirmed herpes simplex virus infection in this patient. Treatment with oral valacyclovir, topical ofloxacin ointment, and 0.1% fluorometholone eye drops resulted in significant clinical improvement. Over the course of 1 month, visual acuity improved from counting fingers at 80 cm to 20/30, corneal lesions healed, and the anterior chamber reformed without the need for surgical intervention.

This case demonstrates that conservative management can be effective for HSK with corneal perforation and anterior chamber collapse, particularly when supported by accurate diagnosis and close clinical monitoring.

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