Atypical Migratory Serpiginous Corneal Epitheliopathy: Unmasking Herpes Simplex Virus Association

Migratory Serpiginous Corneal Epitheliopathy (MSCE) is a rare condition characterized by migrating corneal epithelial lesions with a serpiginous or amoeboid-shaped appearance. Its etiology remains poorly understood, and the condition often presents a diagnostic and therapeutic challenge. Here, we report a case of a recurrent, unilateral MSCE-like lesion in a 25-year-old woman not responding to standard treatments, including repeated corneal debridement, bandage contact lens placement, and superficial keratectomy with postoperative slow tapering of steroids.

Eventually, microbiological testing of corneal epithelial scrapings obtained during a repeat superficial keratectomy revealed the presence of HSV-1 on both immunofluorescence assay and polymerase chain reaction. Although histopathology did not show classical features of HSV, viral cytopathic effects like perinuclear haloes were noted in some epithelial cells.

Based on these findings, our patient was started on topical antiviral therapy (3% acyclovir eye ointment, 5 times daily for 1 month). This led to complete resolution of the lesion, with no recurrence at the last follow-up, 9 months after initiating topical antivirals.

To our knowledge, this is the first reported case associating HSV to MSCE, emphasizing the importance of considering viral etiologies and microbiological evaluation, including virology in atypical, recurrent corneal epitheliopathies.