A report of herpetic necrotizing keratitis following coronavirus disease 2019 infection

Herpetic necrotizing keratitis is a severe ocular manifestation of herpes simplex virus (HSV) infection, often leading to significant visual impairment. We report a case of a 65-year-old female who presented with ocular pain and reduced acuity in the left eye, 2 weeks after a coronavirus disease 2019 (COVID-19) infection, with a relevant history of a herpetic keratitis three decades prior. Examination revealed necrotizing keratitis with stromal necrosis, dendritic epithelial defect, corneal neovascularization, and diffuse conjunctival injection. This was managed concurrently with topical and systemic aciclovir, and topical prednisolone was introduced at the 2-week mark. Recovery to good visual function and resolution of symptoms was achieved. This is a rare case of herpetic necrotizing keratitis following COVID-19 infection and likely represents a reactivation of the latent HSV type 1 by Severe acute respiratory syndrome coronavirus 2. This case emphasizes the importance of recognizing and managing inflammatory ocular complications in individuals with a history of herpetic infections and highlights another potential repercussion of COVID-19.