title: Idiopathic stromal keratitis resembling central toxic keratopathy.
abstract: A 28-year-old previously emmetropic woman presented with a 2-day history of bilateral photophobia and blurred vision. She had no history of corneal surgery or contact lens use. Snellen uncorrected distance visual acuity (UDVA) was 6/12 bilaterally. Bilateral anterior stromal infiltration of the central cornea was seen, with no overlying epithelial defect and intact sensation. There was a marked hyperopic shift, central corneal thinning, and associated keratometric flattening. The patient was started on topical corticosteroids. Over 12 weeks, the UDVA returned to 6/5 with emmetropization of the refractive status and thickening of the central cornea. The clinical findings in our patient resemble those of central toxic keratopathy (CTK) in post-refractive-surgery cases, suggesting a similar mechanism. To our knowledge, this is the first report of a patient presenting with a CTK-like syndrome in the absence of previous keratorefractive surgery or contact lens use. The pathophysiology of this condition remains elusive and requires further investigation.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: vijaybwagh@gmail.com.
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Wagh
authors.affiliation: From the Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: de Benito-Llopis
authors.affiliation: From the Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: David P S
authors.initials: DP
authors.lastname: O'Brart
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003318:Corneal Opacity / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D003319:Corneal Stroma / Q000187:drug effects / Q000473:pathology*; D048988:Corneal Surgery, Laser / Q000009:adverse effects; D019781:Corneal Topography; D003907:Dexamethasone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007634:Keratitis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D003907:Dexamethasone; D015774:Ganciclovir