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BMJ Case Rep ; 14(9)2021 Sep 07.
Article in English | MEDLINE | ID: covidwho-1467682


An 82-year-old man with a history of herpes simplex keratitis 40 years previously presented with recurrence, 1 day following vaccination for novel COVID-19. His condition worsened despite topical treatment with ganciclovir gel. A diagnosis of herpetic stromal keratitis was made, requiring systemic aciclovir, topical prednisolone, moxifloxacin and atropine, and oral doxycycline. He improved clinically on treatment, with some residual corneal scarring. Visual acuity improved from 6/36 corrected at presentation, to 6/24 following treatment. Clearly, public and personal health benefits from vaccination are hugely important and we would not suggest avoiding vaccination in such patients. It is, however, important for ophthalmic providers to be aware of the rare potential for reactivation of herpetic eye disease following vaccination to enable prompt diagnosis and treatment.

COVID-19 , Keratitis, Herpetic , Acyclovir/therapeutic use , Aged, 80 and over , Antiviral Agents/adverse effects , Humans , Keratitis, Herpetic/chemically induced , Keratitis, Herpetic/diagnosis , Keratitis, Herpetic/drug therapy , Male , Prednisolone/therapeutic use , SARS-CoV-2 , Vaccination/adverse effects
Medicina (Kaunas) ; 57(5)2021 Apr 24.
Article in English | MEDLINE | ID: covidwho-1201634


Herpes simplex virus type 1 (HSV-1) is a leading cause of infectious blindness worldwide. Most of the initial infection cases manifest as acute epithelial keratitis. Reactivation of herpesviruses is common in critically ill patients, including patients with severe Coronavirus disease (COVID-19). However, the data on COVID-19-related ocular infections is sparse, despite recent observations that more than 30% of COVID-19-infected patients had ocular manifestations. We report five cases of HSV-1 keratitis in COVID-19 patients. In total, five COVID-19 patients underwent ophthalmic examination, showing similar symptoms, including photophobia, tearing, decreased vision, eye redness, and pain. After initial assessment, tests of visual acuity and corneal sensitivity, a fluorescein staining test, and complete anterior and posterior segment examinations were performed. A diagnosis of HSV-1 keratitis was confirmed in all cases. Therapy was initiated using a local and systemic antiviral approach together with local antibiotic and mydriatic therapy. The complete reduction of keratitis symptoms and a clear cornea was achieved in all patients within 2 weeks. SARS-CoV-2 infection may be a risk factor for developing HSV-1 keratitis, or it may act as a potential activator of this ocular disease.

COVID-19 , Herpesvirus 1, Human , Keratitis, Herpetic , Antiviral Agents/therapeutic use , Humans , Keratitis, Herpetic/diagnosis , Keratitis, Herpetic/drug therapy , SARS-CoV-2
J Cataract Refract Surg ; 46(12): e61-e63, 2020 12.
Article in English | MEDLINE | ID: covidwho-910345


This case report describes a negative result for antigen testing for the SARS-CoV-2 virus in an aqueous sample taken during the management of suspected herpes simplex keratitis from a patient with confirmed SARS-CoV-2 based on antigen testing of high nasal swab. The implications of no viral load detectable in the aqueous sample are discussed in context of routine phacoemulsification surgery during the SARS-CoV-2 pandemic.

Aqueous Humor/virology , COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , Corneal Stroma/virology , Keratitis, Herpetic/diagnosis , SARS-CoV-2/isolation & purification , Antiviral Agents/therapeutic use , COVID-19/genetics , COVID-19/virology , Ganciclovir/therapeutic use , Humans , Keratitis, Herpetic/drug therapy , Keratitis, Herpetic/virology , Male , Middle Aged , Recurrence , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/genetics , Simplexvirus/pathogenicity , Visual Acuity/physiology