Long-Term Follow-up of Epstein Viral Keratitis

A 39-year-old woman diagnosed with chronic fatigue syndrome developed unilateral non-suppurative stromal keratitis (Fig A). Topical steroid therapy led to sharply demarcated opacities consistent with Epstein-Barr viral (EBV) keratitis (Fig B). Antibody (ab) to EBV nuclear antigen was 1:256, to viral capsid antigen 1:320; ab to early antigen was positive. Steroid therapy was discontinued after 1 month. Three months later the cornea was quiet (Fig C). The patient was observed 5 years later, with almost complete clearing of the corneal lesions (Fig D). EBV seropositivity prevalence in the United States is over 90%, yet EBV keratitis is rarely diagnosed. The ability of EBV keratitis to resolve, leaving little evidence of prior significant inflammation, may contribute to the relatively low rate of recognition of EBV keratitis (Magnified version of Fig A-D is available online at www.aaojournal.org).