A Patient With Recurrent Immune Stromal Keratitis and Adherence Challenges.

Background: Herpes simplex keratitis (HSK) is a common yet potentially blinding condition caused by a primary or reactivated herpetic infection of the cornea. Immune stromal keratitis (ISK), a type of HSK, is classified by a cellular and neovascularization infiltration of the cornea, and patients with ISK may experience low-grade chronic keratitis for years.

Case presentation: A 52-year-old man presented to the eye clinic complaining of a watery and itchy right eye with mildly blurred vision. With consultation from a corneal specialist, the patient was given the presumptive diagnosis of ISK in the right eye based on the unilateral corneal presentation and lack of corneal sensitivity.

Conclusions: ISK presents unilaterally with decreased or absent corneal sensitivity and nonspecific symptoms. It should be at the top of the list in the differential diagnosis in any patient with unilateral corneal edema, opacification, or neovascularization, and the patient should be started on oral antiviral therapy.