Herpes simplex virus bullous keratitis misdiagnosed as a case of pseudophakic bullous keratopathy with secondary glaucoma: an unusual presentation.
OBJECTIVE
To report an unusual case of herpetic bullous keratitis misdiagnosed as a case of pseudophakic bullous keratopathy with secondary glaucoma.


RESULTS
A retrospective analysis of the case record of a 60-year-old man who had earlier undergone bilateral cataract surgery, was done. He presented with a complaint of decrease in vision in the right eye of 20 days duration. On examination, cornea showed epithelial bullae all over the surface with stromal and epithelial edema. Intraocular pressure was 30 mm of Hg in RE. He was treated with anti-glaucoma medications. Two dendritic lesions were seen in the cornea during a subsequent visit four days later. Virological investigations confirmed a diagnosis of Herpes simplex keratitis. He was treated with topical acyclovir.


CONCLUSIONS
This case highlights the fact that herpes simplex keratitis can present initially as a more diffuse corneal stromal and epithelial edema with epithelial bullae mimicking bullous keratopathy. Herpetic bullous keratitis, although unusual, should be considered in the differential diagnosis under such circumstances.
Athmanathan
S
S
Jhaveri Microbiology Center, Hyderabad Eye Research Foundation, LV Prasad Eye Institute, India. sreedhar@lvpeye.stph.net
Sridhar
M S
MS
Anand
R
R
Mandal
A K
AK
Rao
G N
GN
D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003315:Cornea / Q000187:drug effects / Q000821:virology*; D003316:Corneal Diseases / Q000150:complications / Q000175:diagnosis*; D015715:Corneal Edema / Q000175:diagnosis; D003319:Corneal Stroma / Q000473:pathology; D003951:Diagnostic Errors; D015726:Giant Cells / Q000473:pathology; D005901:Glaucoma / Q000175:diagnosis* / Q000209:etiology; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D006801:Humans; D016849:Keratitis, Herpetic / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D019591:Pseudophakia / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies
D000998:Antiviral Agents; D000212:Acyclovir