Granulomatous anterior uveitis with Koeppe nodules in recurrent herpetic keratouveitis

Although many cases of anterior uveitis are noninfectious, viruses like Herpes Simplex Virus (HSV) are significant causes of infectious inflammation, often presenting as immune-mediated recurrences. We report an unusual 'granulomatous masquerade' in a 42-year-old male with a history of herpetic stromal keratitis. The patient presented with acute-onset unilateral redness and a best-corrected distant visual acuity (BCVA) of 6/36. Clinical findings included diffuse 'mutton-fat' keratic precipitates and a rare Koeppe nodule at the pupillary margin. Diagnosis was established clinically by the 'corneal footprint' of prior HSV. Following prompt initiation of topical Prednisolone 1% under systemic Valacyclovir cover, inflammation resolved significantly. At the 1-month follow-up, BCVA improved to 6/12, demonstrating a favorable functional response.