Conjunctival ulcers: a rare feature of ocular herpes simplex virus infection

Abstract

A healthy 22-year-old woman presented at Unidade Local de Saúde de Gaia e Espinho with a persistently painful and red left eye of about 5 days’ duration. Prior treatment with dexamethasone+levofloxacin drops from an outside provider had been ineffective. On examination, conjunctival hyperemia and ulcers were observed, in the perilimbal, bulbar, and tarsal conjunctiva, which stained positively with fluorescein under a cobalt-blue filter. No corneal changes were present. Polymerase chain reaction testing was positive for herpes simplex virus type 1 (HSV1). The patient was started on topical ganciclovir (5 times daily) and oral valacyclovir 500 mg (3 times daily), with resolution of the pain and ulcers within 5 days. Herpes simplex infection manifesting as conjunctival ulcers is rare, with fewer than 20 reported cases.