Bilateral Chronic Herpetic Anterior Uveitis in an Immunocompetent Patient.

Abstract

Purpose: To present a case of bilateral herpes simplex anterior uveitis in an immunocompetent patient.

Methods: Case Report.

Results: A 42-year-old Kenyan female presented with a 2-year history of intermittent painful eye redness associated with blurring of vision of both eyes. Symptoms started after childbirth. There were no associated systemic symptoms. She presented with a best corrected visual acuity (BCVA) of 6/18 and 6/30 on the right and left eyes, respectively. On examination, conjunctival hyperaemia, large keratic precipitates (KPs), posterior synechiae, poorly dilating pupil, anterior subcapsular cataract and +2 anterior chamber (AC) cells and flare were noted on both eyes. Intraocular pressures (IOP) were within normal limits. Optical coherence tomography (OCT) showed bilateral cystoid macular oedema (CMO). Serum herpes simplex virus (HSV) IgM was detected, whereas autoimmune and other infectious aetiologies were excluded. Aqueous humour samples from both eyes tested negative for HSV. Bilateral 16 mg subtenon triamcinolone injection were done. Dexamethasone 0.1% eye drops and atropine 1.0% eye drops were started. Topical anti-glaucomatous medication was started due to IOP >30 mmHg on both eyes and Valacyclovir 1g three times a day was initiated. Final visit showed an improvement of BCVA to 6/9 on both eyes. There was complete resolution of AC cells and flare, and CMO on OCT.

Conclusion: The diagnosis of bilateral herpetic anterior uveitis was based on the criteria set by The Herpetic Eye Disease Study (HEDS). Although the patient was immunocompetent, she was in a state of transient immunodeficiency that is pregnancy, which could have led to bilateral ocular involvement.