Herpetic keratitis after corneal crosslinking

Corneal crosslinking is considered a safe procedure even if sight-threatening side effects have been reported. Other han our case report, few reports of herpetic keratitis (HK) after crosslinking have been published. We report a new onset HK after corneal crosslinking for keratoconus. A 40-year-old woman underwent corneal collagen crosslinking in her right eye for progressive keratoconus. The patient returned with pain and photophobia. Infiltration in the corneal stroma was observed. Fluorescein staining specified epithelial defects overlying the corneal infiltrates. The diagnostic of HK was confirmed with polymerase chain reaction for DNA detection of HSV type 1 of corneal swab. The epithelial defect healed with oral valacyclovir treatment. Topical corticosteroid drops and preservative-free lubricant eye drops were, also, added to the antiviral treatment. Afterwards, a decrease in stromal infiltrate was observed. This case report highlights the risk of HK after crosslinking and elucidates the importance of timely diagnosis of this unusual but important complication. The ophthalmologist should be aware of the possibility of HK in eyes after crosslinking, even in patients without a past medical history of HSV infection.