Herpes simplex Keratitis Mimicking Acute Corneal Hydrops

Purpose: The purpose of this paper is to present a case of a Herpes simplex keratitis presenting as a case of acute corneal hydrops. Methods: Case report. Results: A 57-year-old white woman presented with acute onset of pain, photophobia and decreased vision in the left eye. In the years prior, she had been under the care of her optometrist, who had previously diagnosed her with irregular astigmatism, for which she had been using rigid gas permeable contact lenses for vision correction. At the slit-lamp biomicroscope, the left eye was found to have marked corneal edema with central endothelial folds, as well as a round, paracentral area of stromal haze and opacity. The fellow eye was shown to have inferior areas of anterior stromal scarring. Corneal topography showed markedly irregular astigmatism, with inferior steepening bilaterally. These are findings that could also be seen in acute corneal hydrops. In this case, a diagnosis of Herpes Simplex keratitis was made, and patient showed marked improvement on oral valacyclovir. Conclusions: Herpes simplex keratitis can often be a diagnostic challenge, as it can present itself in various forms. We report a case of Herpes simplex keratitis mimicking acute corneal hydrops.