Recurrent Corneal Erosion as a Presentation of Herpes Simplex Virus Infection: A Diagnostic Dilemma

Abstract

Recurrent corneal erosion (RCE) is a painful disorder most commonly associated with antecedent trauma or epithelial basement membrane dystrophy. Viral etiologies, particularly herpes simplex virus (HSV), have also been implicated and may present without classic features of herpetic epithelial keratitis, leading to diagnostic challenges. A 66-year-old male presented with recurrent episodes of corneal epithelial breakdown. Initial treatment with topical corticosteroids and oral acyclovir resulted in temporary improvement, but symptoms recurred. Clinical features suggestive of herpetic involvement prompted further evaluation. Polymerase chain reaction and immunofluorescence assay testing confirmed HSV infection. Long-term oral antiviral therapy led to complete resolution with no recurrence at 1-year follow-up. HSV can present as RCE even in the absence of classic epithelial keratitis. This case highlights the importance of molecular diagnostic testing in persistent corneal erosions of unclear etiology and supports the role of prolonged antiviral therapy in preventing recurrence.