Idiopathic stromal keratitis resembling central toxic keratopathy

A 28-year-old previously emmetropic woman presented with a 2-day history of bilateral photophobia and blurred vision. She had no history of corneal surgery or contact lens use. Snellen uncorrected distance visual acuity (UDVA) was 6/12 bilaterally. Bilateral anterior stromal infiltration of the central cornea was seen, with no overlying epithelial defect and intact sensation. There was a marked hyperopic shift, central corneal thinning, and associated keratometric flattening. The patient was started on topical corticosteroids. Over 12 weeks, the UDVA returned to 6/5 with emmetropization of the refractive status and thickening of the central cornea. The clinical findings in our patient resemble those of central toxic keratopathy (CTK) in post-refractive-surgery cases, suggesting a similar mechanism. To our knowledge, this is the first report of a patient presenting with a CTK-like syndrome in the absence of previous keratorefractive surgery or contact lens use. The pathophysiology of this condition remains elusive and requires further investigation.

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