Herpetic Keratouveitis: Missed Diagnosis Leading to Corneal Perforation

Herpetic uveitis is an easy diagnosis to miss, which can lead to devastating consequences. The aim of this report is to create awareness of how this disease can present, appropriate clues to the diagnosis, and how it should be managed. We report a case of a 70-year-old female who presented with redness and painless blurry vision in her right eye and was treated with topical corticosteroid drops for presumed idiopathic anterior uveitis. Despite initial symptomatic improvement, she reattended with a significant deterioration in vision and was found to have a large corneal infiltrate and associated perforation. The perforation was sealed with corneal gluing, and she was treated for presumed herpetic anterior uveitis with oral acyclovir. Corneal polymerase chain reaction (PCR) specimen was positive for herpes simplex virus DNA. The perforation started to leak again despite repeat corneal gluing, so an emergency therapeutic penetrating keratoplasty was performed. She has remained on prophylactic oral acyclovir for the last 24 months, with no recurrence and the graft remains clear.