Corneal endothelium in herpetic keratouveitis

The corneal endothelium underwent changes in 15 patients with unilateral herpetic keratouveitis. Study with both noncontact and wide-field specular microscopes showed that six patients had mild and nine patients severe keratouveitis. Transient endothelial changes indicating endotheliitis were observed in all eyes affected by severe keratouveitis. In three cases nonreflecting areas were observed with the specular microscope one to two days earlier than the conventional signs of anterior uveitis. This finding suggests direct herpes simplex virus invasion into endothelial cells that could be followed by an inflammatory cell attack against the endothelium. The eyes that had experienced severe keratouveitis showed marked pleomorphism of the endothelial cells and a 15% lower central endothelial cell density on average than the healthy fellow eyes. In the eyes with mild keratouveitis, the endothelial mosaic showed only a 1.4% lower endothelial cell density.