Case report
A 46-year-old patient was transferred from a peripheral
hospital as a case of closed globe injury with a corneal ulcer.
The patient gave a history of being hurt in his right eye while
playing basketball, 2 weeks back. 3 days after the injury he
reported with pain and mild diminution of vision in his right
eye. The treating doctor documented his vision as 6/9 right
and 6/6 left eye. He also noticed a small corneal opacity in his
right eye. The patient was admitted as a case of closed globe
injury with corneal ulcer and started on topical and systemic
broad-spectrum antibiotics and analgesics. However over the
next 10 days, the patient’s condition deteriorated with
increasing pain, further diminution of vision and an increase
in size of the corneal opacity. He was subsequently transferred
to this center. On presentation, the vision in his right
eye was reduced to just 2/60. There was also severe circumcorneal
congestion with a large nebulo-macular grade
central corneal ulcer (Fig. 1). His intra-ocular pressure (IOP)
however was normal i.e. 16 mm of Hg both eyes as measured
with a non-contact tonometer (NCT). On staining with fluorescein,
the classical branching dendritic pattern of herpes
simplex keratitis was seen (Fig. 2). The patient was started on
systemic and topical antivirals i.e. tablet acyclovir 400 mg five
times daily as well as eye ointment acyclovir 0.3% five times