Sectorial corneal infiltrates and pannus in herpes zoster ophthalmicus

Abstract

We report four patients with herpes zoster ophthalmicus who developed a dense pannus limited to a sector of the superior cornea that advanced to the central region of the cornea. The pannus appeared to develop in response to peripheral infiltrates in a subepithelial or anterior stromal location and not in association with disciform corneal edema, interstitial keratitis, or scleritis. The corneal pannus developed insidiously as a late complication without associated ulceration and with little or no anterior uveitis or conjunctival reaction. Additionally, all four patients developed anterior and mid-stromal infiltrates in a punctate or incomplete ring configuration at the leading border of the pannus that threatened the visual axis. In the three patients that were treated with topical corticosteroids, the infiltrates resolved with preservation of visual acuity. The other patient developed central scarring with a permanent reduction in vision. Patients with infiltrates and pannus in a sector of the cornea should be followed carefully and treated with topical corticosteroids when infiltrates appear to prevent progression to the central cornea.