Anterior segment OCT findings and atypical refractive changes secondary to Epstein-Barr virus–associated nummular keratitis

Abstract

Introduction: This case study described refractive changes that can occur in the setting of Epstein-Barr virus (EBV)-associated nummular keratitis (NK) and highlighted the role that anterior segment optical coherence tomography can serve in diagnosis and management of this disease. Patient and Clinical Findings: A 15-year-old girl developed subepithelial and anterior stromal corneal lesions and experienced progressive decline in the corrected distance visual acuity. She also developed a significant myopic shift with increased keratometric and refractive astigmatism. Diagnosis, Intervention, and Outcomes Targeted laboratory testing was performed. A diagnosis of chronic EBV-associated NK was made, and the patient was treated with systemic valacyclovir and topical steroids. Clinical appearance of lesions and corrected distance visual acuity improved, although refractive and keratometric changes persisted. Conclusions: Significant and persistent refractive changes can occur in the setting of EBV-associated NK, similar to those seen after conductive keratoplasty. Anterior segment optical coherence tomography can be a potentially helpful supplementary diagnostic imaging modality to avoid invasive testing in such cases.