title: In vivo confocal microscopy in bilateral herpetic keratitis: a case report.
abstract: 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.
authors.affiliation: Ophthalmology and Neurosurgery Department, University of Siena, Siena - Italy. gianlucamartone@unisi.it
authors.forename: G
authors.initials: G
authors.lastname: Martone
authors.forename: M
authors.initials: M
authors.lastname: Alegente
authors.forename: A
authors.initials: A
authors.lastname: Balestrazzi
authors.forename: E
authors.initials: E
authors.lastname: Nuti
authors.forename: C
authors.initials: C
authors.lastname: Traversi
authors.forename: P
authors.initials: P
authors.lastname: Pichierri
authors.forename: G M
authors.initials: GM
authors.lastname: Tosi
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir