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Updated: Feb 14, 2026

Ex Vivo Organotypic Corneal Model of Acute Epithelial Herpes Simplex Virus Type I Infection
Published on: November 3, 2012
Corneal perforation after noncontact tonometry in patients with active recurrent herpes simplex keratitis: case
Napaporn Tananuvat1, Atitaya Apivatthakakul2, Chulaluck Tangmonkongvoragul2
1Department of Ophthalmology, Chiang Mai University, Chiang Mai, 50200, Thailand. ntananuvat@gmail.com.
Purpose:
To report iatrogenic complications and to review the potential complications caused by noncontact tonometry (NCT) in related literature.
Methods:
This case report describes two cases of active recurrent herpes simplex keratitis (HSK) on top of a thin corneal scar. The cornea was perforated by the air pulse from the NCT, resulting in an air bubble in the anterior chamber.
Results:
Both patients were diagnosed with active recurrent necrotizing stromal HSK on top of a thinned corneal scar after previous therapeutic treatment involving tissue adhesive glue with a bandage contact lens (BCL) to treat a perforated cornea. During a follow-up visit, both patients reported similar symptoms of acute pain and fluid exuding from their eyes immediately after undergoing NCT. Slit-lamp examination revealed a perforated cornea with an intracameral air bubble. Treatment involved use of tissue adhesive glue and BCL in both cases.
Conclusion:
NCT may not be sufficiently safe in patients with active infectious keratitis, particularly in cases where the cornea is relatively thin and necrotic.
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