Cornea Cases

Title:

Bilateral multifocal corneal thinning after COVID-19 infection

Case Report Details

First Author: G.Kontadakis UK

Co Author(s):    P. Georgoudis                    

Abstract Details

Purpose:

We are reporting a case of bilateral multifocal keratitis that developed in a patient after suffering COVID-19 systemic infection.

Setting:

Whipps Cross University Hospital

Report of case or case series:

A 55-year-old patient presented with persistent symptoms of bilateral photophobia and discomfort that started after COVID-19 infection and gradually became more severe for 3 months. In clinical examination, both eyes were hyperaemic, and multifocal stromal thinning with or without epithelial defect was evident in both eyes. The lesions were central, paracentral and peripheral and one of the peripheral lesions seemed to have ulceration with infiltration. Anterior segment OCT revealed thinning up to 30%. PCR work-up for adenovirus, and herpes viruses as well as corneal scrapes from the ulcerated lesion were negative. Initial treatment with intense lubrication and topical antibiotics was unsuccessful. A bandage contact lens was placed and improvement was minimal. The addition of topical steroids improved significantly the symptoms in both eyes and facilitated epithelium healing. Topical cyclosporine was added for long term use after discontinuation of steroids.

Conclusions/Take Home Message:

Unlike typical post-viral subepithelial infiltrates that are usually elevated lesions, this patient presented with multifocal loss of stroma with or without localized epithelial defects. Keratoconjunctivitis has been reported in conjunction with COVID-19 infection. In our case, we hypothesize this was a delayed immunological response and unlike typical elevated subepithelial lesions, presented with excavated stromal lesions.