A cornea consumed

This is peripheral ulcerative keratitis in a man in his 60s who presented with a six week history of worsening photophobia, blurred vision, and painful red right eye (fig 1). He also reported having cold sores previously. Examination showed thinning on the nasal side of the right cornea, with accompanying new blood vessel formation and loss of corneal sensation. Fluorescein staining and ocular ultrasonography supported the diagnosis of peripheral ulcerative keratitis. This inflammatory condition affects the peripheral part of the cornea and can lead to permanent damage requiring corneal grafts if left untreated.1 It may be associated with systemic conditions such as rheumatoid arthritis and vasculitis.12 In this patient, thorough investigation did not suggest a systemic condition, and the presentation was deemed likely secondary to chronic herpes simplex virus infection. Symptoms and visual acuity improved after treatment with oral aciclovir and antibiotic eye drops.bmj;381/may03_3/e074196/F1F1f1Fig 1
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