A case of herpes simplex keratouveitis diagnosed by real time polymerase chain reaction.

ABSTRACT

A 59‑year‑old Asian Indian male presented with complaints of left eye blurring of vision associated with on and off episodes eye pain and redness since last 4 months. On examination, his best corrected visual acuity in the right eye was 6/15, N12 and left eye counting finger at 2 m, <N36. Anterior segment examination of the left eye revealed circumciliary congestion, corneal edema, mutton fat pigmented keratic precipitates, and dilated pupil with complicated cataract [Fig. 1a and b]. Intraocular pressure (IOP) in the right eye was 18 and left eye 48 mmHg. On the basis of history and clinical examination, a probable diagnosis of viral anterior granulomatous keratouveitis was made. The patient was started on topical prednisolone, homatropine, and empirical tablet acyclovir. Patient was also advised tablet. Acetazolamide, topical antiglaucoma medications (timolol and brinzolamide) in left eye to control IOP. Anterior chamber tap was done in left eye for real time polymerase chain reaction (RT‑PCR) for herpes simplex virus (HSV). RT‑PCR report was positive for HSV [Fig. 2a and b]. The patient was started with T. valacyclovir 1 g 3 times and tapering dose of topical prednisolone. The patient is on follow‑up and responding well to the treatment.