A 39-year-old man, complained about a 3-day history of bilateral blurred vision. He had a past medical history of kidney transplantation 5 years ago and was receiving systemic immunosuppressive therapy. The patient was hospitalized for chickenpox and was treated with systemic antivirals 3 weeks prior to ocular symptoms onset. On ophthalmic examination, the patient’s best corrected visual acuity (BCVA) was 20/200 in the right eye (RE) and 20/25 in the left eye (LE). Slit-lamp examination showed stromal keratitis and few fine keratic precipitates in the RE (Fig. ) and 1+ anterior chamber cells in both eyes. Intraocular pressure was 22 mmHg in the RE and 20 mmHg in the LE. There were no vitreous cells, and results of dilated fundus examination were unremarkable in both eyes. The patient was diagnosed with keratouveitis in the RE and acute anterior uveitis in the LE secondary to chickenpox. He was treated with topical acyclovir five times a day, dexamethasone six times a day, beta blockers, and atropine 1% twice daily. He was lost to follow-up. One year later, he presented with a 1-week history of blurry vision bilaterally. On ophthalmic examination, BCVA was 20/200 in the RE and 20/30 in the LE. Slit-lamp examination showed “mutton-fat” pigmented keratic precipitates (Fig. ), 1+ anterior chamber cells, corneal scars, patchy iris atrophy with circumscribed depigmented spots of the iris, and distorted pupil (Fig. ) in both eyes. Intraocular pressure was 27 mmHg in the RE and 24 mmHg in the LE. Assessment of posterior segments revealed no abnormalities in both eyes. A diagnosis of recurrent granulomatous anterior uveitis was made. The patient was treated with topical dexamethasone six times a day, topical acyclovir five times a day, beta blockers, and atropine 1% twice daily. Intraocular inflammation gradually resolved, and visual acuity improved. Topical steroids and acyclovir were slowly tapered. Visual acuity improved to 20/25 in both eyes one month after presentation. No recurrence of intraocular inflammation was observed over a follow-up period of 24 months.
A 40-year-old otherwise healthy woman noticed pain, redness, watering, photophobia, and decreased vision in both eyes one week after the onset of severe chickenpox. On examination, BCVA was counting fingers in the RE and 20/200 in the LE. Slit-lamp examination showed perilimbal injection and a geographic corneal epithelial defect associated with diffuse stromal edema in both eyes (Fig. ). The anterior chamber was deep and quiet, and there were no vitritis or abnormal fundus findings.\nA diagnosis of varicella keratitis was made. The patient was treated with systemic acyclovir (30 mg/kg/day). Oral steroids (0.5 mg/kg/day) were added 6 days after antiviral treatment, because of the severe associated stromal edema. The corneal defect resolved slowly within 2 weeks, and the medication was discontinued.\nThree months later, the patient presented with complaints of decreased vision and eye pain bilaterally. On examination, BCVA was 20/35 in both eyes. Slit-lamp examination showed perilimbal injection, many small raised dendriform lesions, and marginal infiltrates in the cornea of both eyes. A diagnosis of recurrent varicella keratitis was made, and the patient was once again treated with systemic acyclovir (30 mg/kg/day) and oral steroids (0.5 mg/kg/day) 4 days later. Corneal lesions resolved within 2 weeks with residual peripheral corneal scars (Fig. ), and visual acuity improved to 20/25 in both eyes. No recurrence of keratitis was observed after 18 months of follow-up.