Reactivation of herpes simplex keratitis following vaccination for COVID-19

Abstract

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.

Keywords: anterior chamber; ophthalmology; public health.

Figure 1

The patient’s clinical appearance 1 week after beginning topical treatment. The eye is significantly inflamed, with corneal neovascularisation, epithelial defect and stromal opacity. The pupil is pharmacologically dilated.

Figure 2

The same eye following treatment. The inflammation has settled and the epithelial defect has closed. There is evidence of corneal scarring inferiorly which is encroaching on the visual axis.