Reactivation of herpes simplex keratitis following vaccination for COVID-19

An 82-year-old man with a history of herpes simplex keratitis 40 years previously presented with recurrence, 1 day following vaccination for novel COVID-19. His condition worsened despite topical treatment with ganciclovir gel. A diagnosis of herpetic stromal keratitis was made, requiring systemic aciclovir, topical prednisolone, moxifloxacin and atropine, and oral doxycycline. He improved clinically on treatment, with some residual corneal scarring. Visual acuity improved from 6/36 corrected at presentation, to 6/24 following treatment. Clearly, public and personal health benefits from vaccination are hugely important and we would not suggest avoiding vaccination in such patients. It is, however, important for ophthalmic providers to be aware of the rare potential for reactivation of herpetic eye disease following vaccination to enable prompt diagnosis and treatment.

Automated summary

An 82-year-old man with a history of herpes simplex keratitis experienced recurrence 1 day after receiving the novel COVID-19 vaccine. Despite worsened condition, treatment with systemic aciclovir, prednisolone, moxifloxacin, atropine, and oral doxycycline led to clinical improvement and improved visual acuity. While the benefits of vaccination are important, ophthalmic providers should be aware of the rare potential for reactivation of herpetic eye disease following vaccination for prompt diagnosis and treatment.