Herpes simplex keratitis following coronavirus disease 2019 vaccination: an observational study of forty-three cases with different presentations

Abstract

Objective The aim of this study was to evaluate the cases diagnosed with different presentations of herpes simplex virus (HSV) keratitis following coronavirus disease 2019 (COVID-19) vaccination and to describe the relationship between the disease presentation, the type of vaccine, and the duration between vaccination and disease onset. Patients and methods This is a retrospective observational clinical study of HSV keratitis cases that was carried out by the Cornea Team at Alexandria Ophthalmology Hospital, Alexandria, Egypt, between March and September 2022. Full medical and ophthalmic history was taken, followed by a thorough ophthalmic examination. The vaccination data of the patients were recorded. The hospital records of the patients visiting the outpatient clinics, at that period, were collected regarding the number of vaccinated and nonvaccinated patients and the type of vaccine received. Results The study included 43 eyes of 43 patients. Typical dendritic corneal ulcer occurred in 21 (48.8%) eyes, while 5 (11.6%) eyes presented with a geographic ulcer, and 14 (32.6%) eyes were diagnosed as interstitial keratitis with or without ulceration. The remaining 3 (6.98%) eyes presented with disciform keratitis. Vaccination was previously received by 40 (93.02%) patients, while only 3 patients did not receive any vaccine. Oxford-Astra Zeneca vaccine was received by 14 (35%) patients, while the Pfizer-BioNTech vaccine was received by 13 (32.5%) patients, Sinovac vaccine by 10 (25%) patients, and other types of vaccines by three (7.5%) patients. The duration between the last dose received from the vaccine and the onset of symptoms ranged between 2 and 58 days (mean=18.35±13.3 days). Reviewing the hospital records, out of the 65 321 patients who visited the hospital during that period, 47% were nonvaccinated, and 53% were vaccinated with one dose or more of COVID-19 vaccine (Odds ratio=11.8207 indicating a significant association between HSV keratitis and vaccination). Conclusion Reactivation of HSV keratitis may follow COVID-19 vaccination with different presentations of herpetic keratitis. The Oxford-AstraZeneca and the Pfizer-BioNTech vaccines were significantly associated with HSV ocular infection more than any other type of vaccine.