Bilateral viral keratitis following corneal collagen crosslinking for progressive keratoconus

Corneal collagen crosslinking has been proven to be a useful technique to slow the progression of keratoconus. With its increasing use, we are encountering rare complications. We describe a case that developed bilateral viral keratitis after corneal collagen crosslinking with riboflavin and ultraviolet A for progressive keratoconus.

An 18-year-old boy underwent corneal collagen crosslinking in both the eyes at the same setting for bilateral progressive keratoconus. He was discharged with a soft bandage contact lens and asked to follow up in 5 days. Seven days later, the patient returned with severe pain, redness, and photophobia for the last 2 days. The bandage contact lens was removed. There was a central corneal lesion in a branching dendritic pattern in both the eyes and the corneal sensation was reduced. Based on the findings, a clinical diagnosis of bilateral viral keratitis was made. The dendrite healed completely in 10 days with oral and topical acyclovir treatment, and the cornea had a faint scar at 1 month follow-up with best-corrected visual acuity of 6/9 in both eyes with a rigid gas permeable lens.

Ultraviolet A light could be a stimulus to trigger reactivation of latent HSV infections even in patients with no history of clinically evident herpes virus ocular infections. Early diagnosis and timely treatment can have good visual outcome. Prophylactic antiviral medication may be useful to prevent this complication in individuals with prior history of viral keratitis.