Herpes simplex epithelial keratitis (HSK) following cataract surgery can be misdiagnosed early on in the post-op period, since it is an uncommon complication following the procedure, a recent study in the June issue of Cornea reported.

Researchers examined whether the temporal corneal penetrating incisional approach used in routine cataract surgery interrupted the corneal nerves and subsequently triggered reactivation of HSK. The investigators used a retrospective chart review of 666 eyes in 666 patients who underwent cataract surgery to evaluate the incidence of epithelial keratitis and related factors in the postoperative period. They found that postoperative epithelial keratitis developed in 15 eyes, and 11 of the 15 were diagnosed with HSK.

All patients diagnosed with HSK had no previous clinical history of the infection before undergoing cataract surgery. Initially, the diagnosis of all 15 eyes was toxic keratitis. Researchers also found the incision location was related to the occurrence of HSK, with 10 of the 11 cases occurring in patients who received a temporal corneal incision; the remaining case used a superotemporal location.

“We suggest that regardless of the patient’s previous history of keratitis,” the authors wrote, “if the patient develops typical or atypical punctate epithelial keratitis in the early postoperative period after cataract surgery (especially with a temporal clear corneal incision), close follow-up and empiric treatment of HSK are warranted.”

Cho YI, Kwon JW, Konda S, Ambati BK. Epithelial keratitis after cataract surgery. Cornea. 2018;37(6):755-59.