Abstract
Purpose To report degeneration of subbasal corneal nerves and the subsequent neuroregeneration in a case of acute ultraviolet (UV) keratitis, treated with autologous serum eye drops. Methods Case report. Results A 37-year-old female presented with ocular discomfort and blurred vision in both eyes, after exposure to UV-C light in a laboratory. On exam, she had bilateral conjunctival injection and superficial punctate keratitis (SPK), worse in the left, consistent with acute, bilateral, but asymmetric UV-C keratitis. She was initially started on antibiotic ointment and lubricant eye drops. On her follow-up visit 3 days later, corneas had persistent SPK bilaterally. Laser scanning in vivo confocal microscopy (IVCM) showed beading of subbasal corneal nerves in the right eye and decreased subbasal corneal nerve density and numerous amputated nerves in the left eye. Autologous serum eye drops 20%, eight times a day, and loteprednol 0.5% ophthalmic solution were commenced in both eyes. Twelve weeks later, her symptoms fully resolved; IVCM revealed near-normal subbasal corneal nerve density in both eyes. Conclusions IVCM demonstrated dramatic damage to subbasal corneal nerves after brief UV-C exposure. The patient, treated with autologous serum eye drops in both eyes, achieved resolution of symptoms and recovery of subbasal corneal nerves.
Highlights
Ultraviolet (UV) keratitis is characterized by severe ocular pain and decreased visual acuity (VA) six to twelve hours after a relatively short exposure to light sources [1]
Using laser in vivo confocal microscopy (IVCM), we have recently demonstrated a dramatic decrease in subbasal corneal nerves in patients with various types of microbial keratitis and in patients with corneal neuropathy-induced photoallodynia [2, 4, 6,7,8]
The symptoms and signs were more severe in her left eye than those in the right eye, potentially due to a protective effect of the contact lens worn in the right eye
Summary
Ultraviolet (UV) keratitis is characterized by severe ocular pain and decreased visual acuity (VA) six to twelve hours after a relatively short exposure to light sources [1]. Acosta et al have demonstrated that sensitization of nociceptors and depression of cold thermoreceptor activity can occur in UV-induced keratitis in guinea pigs [3]. They suggested that changes in nerve activity possibly underlie the sensation of discomfort and pain, which are associated with ocular surface inflammation induced by UV exposure. Using laser IVCM, we have recently demonstrated a dramatic decrease in subbasal corneal nerves in patients with various types of microbial keratitis and in patients with corneal neuropathy-induced photoallodynia [2, 4, 6,7,8]. We report, for the first time, the alterations and acute degeneration of subbasal corneal nerves, followed by complete subbasal corneal nerve regeneration and resolution of symptoms in a patient with acute UV keratitis, treated with autologous serum eye drops
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