Atypical Migratory Serpiginous Corneal Epitheliopathy: Unmasking Herpes Simplex Virus Association

Purpose: Migratory Serpiginous Corneal Epitheliopathy (MSCE) is a rare condition characterized by migrating corneal epithelial lesions with a serpiginous or amoeboid-shaped appearance. Its etiology remains poorly understood, and the condition often presents a diagnostic and therapeutic challenge. Here, we report a case of a recurrent, unilateral MSCE-like lesion in a 25-year-old woman not responding to standard treatments, including repeated corneal debridement, bandage contact lens placement, and superficial keratectomy with postoperative slow tapering of steroids. Methods: Eventually, microbiological testing of corneal epithelial scrapings obtained during a repeat superficial keratectomy revealed the presence of HSV-1 on both immunofluorescence assay and polymerase chain reaction. Although histopathology did not show classical features of HSV, viral cytopathic effects like perinuclear haloes were noted in some epithelial cells. Results: Based on these findings, our patient was started on topical antiviral therapy (3% acyclovir eye ointment, 5 times daily for 1 month). This led to complete resolution of the lesion, with no recurrence at the last follow-up, 9 months after initiating topical antivirals. Conclusions: To our knowledge, this is the first reported case associating HSV to MSCE, emphasizing the importance of considering viral etiologies and microbiological evaluation, including virology in atypical, recurrent corneal epitheliopathies.