Sterile Infiltrates After Corneal Collagen Cross Linking

This case series describes 3 keratoconic eyes that developed sterile keratitis and subsequent corneal scarring after collagen cross linking (CXL). Medical Records of 3 subjects who underwent Epi-Off CXL for keratoconus from 2020-2024 and developed sterile keratitis were retrospectively reviewed. Subjects presented with decreased vision, conjunctival injection, and stromal infiltrate 4, 6, and 8 days post-CXL. Topical ofloxacin, topical prednisolone, and oral valacyclovir were prescribed to cover infectious and sterile keratitis. Negative cultures and lack of response to antibiotics supported sterile keratitis diagnosis. After increasing topical prednisolone, all three cases showed hastened recovery of active stromal infiltrates and improvement of corneal haze. Establishing early clinical concern for sterile keratitis after CXL, allows for more prompt medication adjustments after infectious etiologies have been ruled out. Earlier treatment of sterile keratitis would likely lead to reduced corneal scarring and improved visual acuity reducing need for corneal transplant.