In vivo confocal microscopy in bilateral herpetic keratitis: a case report.
OBJECTIVE
Bilateral herpetic keratitis is a rare infection of the cornea. Ocular herpes in atopic patients is more often bilateral, with more frequent recurrences. The authors report a case of bilateral herpes simplex virus (HSV) keratitis during the active phase studied by in vivo confocal microscopy.


METHODS
A 28-year-old man with 5 years history of unilateral HSV keratitis and atopic dermatitis was referred to the authors for a clinical and diagnostic evaluation.RESULTS. The corneas showed the typical features of dendritic HSV keratitis in both eyes. Examination by in vivo confocal microscopy demonstrated similar lesions in both eyes: a distortion of the superficial and basal epithelium and the presence of irregular hyperreflective structures and dendritic particles near the epithelial cells. The subbasal nerve plexus presented a tortuous appearance with hyperreflective areas and beadlike formations along the fibers. After a week of antiviral treatment, in vivo confocal microscopy examination demonstrated an irregular epithelium with highly reflective deposits and reflective areas. A reduction of nerve fiber bundles with a large number of beadlike formations and abnormal tortuosity was also noted.


CONCLUSIONS
In vivo confocal microscopy enables a noninvasive evaluation of the ocular surface at a high magnification level. It could be useful for the early and differential diagnosis of corneal infections and when HSV keratitis recurrence is suspected.
Martone
G
G
Ophthalmology and Neurosurgery Department, University of Siena, Siena - Italy. gianlucamartone@unisi.it
Alegente
M
M
Balestrazzi
A
A
Nuti
E
E
Traversi
C
C
Pichierri
P
P
Tosi
G M
GM
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000175:diagnosis; D004279:DNA, Viral / Q000032:analysis; D019573:Epithelium, Corneal / Q000473:pathology; D007839:Functional Laterality; D018259:Herpesvirus 1, Human / Q000235:genetics; D006801:Humans; D016849:Keratitis, Herpetic / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D018613:Microscopy, Confocal; D016133:Polymerase Chain Reaction; D014792:Visual Acuity
D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir