Case Report December 10, 2025 December 10, 2025

Atypical presentation of herpetic keratitis in an infant

DOI: 10.37039/1982.8551.20250100

ABSTRACT

This case report describes the clinical presentation and management of a 38-day-old infant referred to the Ophthalmology Service for evaluation of conjunctival hyperemia, corneal opacity, and eyelid edema in the left eye. The patient was initially diagnosed by the pediatrician with bacterial conjunctivitis and was prescribed a combination of topical corticosteroid and antibiotic drops, with worsening of symptoms over the following five days. Ophthalmologic examination revealed moderate conjunctival hyperemia and an extensive corneal lesion with a clear base and a geographic aspect. Despite the absence of vesicular lesions on the eyelids, the clinical course and the characteristic geographic aspect of the lesion raised the suspicion of herpetic keratitis, leading to the initiation of systemic antiviral therapy. Subsequent laboratory tests indicated exposure to herpes simplex virus. Management included intravenous acyclovir and discontinuation of topical corticosteroids, resulting in marked clinical improvement within a few days. This case highlights the critical importance of considering herpetic keratitis in neonatal and infant ocular infections and the potential severity of herpes simplex virus infections, particularly regarding long-term visual outcomes. Moreover, it reinforces the need for accurate diagnosis and awareness of the risks associated with inappropriate topical corticosteroid use, emphasizing a cautious therapeutic approach.