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63 year old woman with red eye
Digital Journal of Ophthalmology 2002
Volume 8, Number 6
July 1, 2002
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Dimitri Azar, M.D. | Massachusetts Eye and Ear Infirmary, Boston MA
Fina CaƱas Barouch, M.D. | Massachusetts Eye and Ear Infirmary, Boston MA
A 63 year old woman presented to an outside ophthalmologist with foreign body sensation, irritation, photophobia, and tearing OD. Slit lamp exam notable only for superficial punctate keratitis OD. She was treated with erythromycin ointment with some improvement.

She re-presented to her outside ophthalmologist with worsening OD photophobia, redness, tearing, blurry vision, and pain. Corneal sensation was noted to be absent OD but intact OS. The xam was notable for eyelids without vesicles, conjunctival injection, corneal epithelial irregularity with small defect, mild corneal edema, keratic precipitates, and mild anterior chamber reaction.

A pressumptive diagnosis of herpes simplex virus (HSV) keratouveitis was made, and she was started on oral acyclovir (800mg 5x/day). Initially her symptoms improved slightly, but 1 week later she developed worsening corneal edema and anterior chamber reaction. Pred Forte was added TID resulting in reduced corneal edema and anterior chamber reaction. However, two weeks later, she developed worsening photophobia and pain.

She presented to the Massachusetts Eye and Ear Infirmary for a second opinion.

Previous ocular history: Myopia (rigid gas permeable contact lenses x 40 years)

Past Medical History: Chicken pox as a child

Medications: none

Family and Social History: non-contributory