Case report of interstitial keratitis in pregnancy

Abstract

Purpose: To report an unusual case of interstitial keratitis and lipid keratopathy in a pregnant woman with unknown etiology and atypical clinical course.

Observations: A 15 weeks pregnant 32-year-old female daily soft contact lens wearer presented with 1 month of right eye redness and intermittent blurry vision. Slit lamp examination revealed sectoral interstitial keratitis with stromal neovascularization and opacification. No underlying ocular or systemic etiology was identified. The corneal changes were unresponsive to treatment with topical steroids and progressed over the ensuing months of her pregnancy. On continued follow up, the cornea demonstrated spontaneous partial regression of the opacification in the post-partum period.

Conclusions and importance: This case illustrates a possible rare manifestation of pregnancy physiology in the cornea. It also emphasizes the utility of close follow-up and conservative management in pregnant patients with idiopathic interstitial keratitis not only to avoid intervention during pregnancy but also because of the possibility of spontaneous improvement or resolution of the corneal changes.

Keywords: Interstitial keratitis; Lipid keratopathy; Pregnancy.

Fig. 1

Slit lamp image of the patient's right eye at the time of presentation showing significant nasal conjunctival injection and adjacent stromal interstitial keratitis with fine vascularization.

Fig. 2

Slit lamp images of the patient's right eye at various time points in the clinical course including 2 (A), 3 (B), 12 (C), and 18 (D) months after initial presentation. At 2 months following initial presentation, clinical exam showed focal injection and an adjacent area of interstitial keratitis with worsening stromal opacification and neovascularization (A). A month later, the cornea demonstrated increased opacification and lipid deposition (B). In the post-partum period and 12 months after initial presentation, the region of opacification was beginning to regress clinically (arrows; angle at which slit lamp photo was taken at month 12 more oblique compared to B and D). 1.5 years after initial presentation (and 11 months post-partum), decreased stromal vascularization and opacification was seen (arrow).