Diagnostic Role of Anterior Segment Optical Coherence Tomography in an Atypical Presentation of Varicella Zoster Virus Interstitial Keratitis: A Case Report

    February 2026 in “ American Journal of Case Reports ”
    Khalid Alsaggaf, Deema E. Jomar, Samar A. Al-Swailem
    TLDR AS-OCT is crucial for diagnosing VZV interstitial keratitis and avoiding unnecessary treatments.
    This case report discusses a 26-year-old woman with an atypical presentation of varicella zoster virus (VZV) interstitial keratitis, initially suspected to be corneal intraepithelial neoplasia (CIN). The patient experienced unilateral headache, alopecia, eyelash loss, and redness over 5 years. Anterior segment optical coherence tomography (AS-OCT) and epithelial mapping were crucial in diagnosing VZV interstitial keratitis, distinguishing it from CIN. Treatment with oral valacyclovir and topical corticosteroids resolved the keratitis within 1 month, leaving residual scarring. The report emphasizes the importance of considering infectious causes like VZV in atypical corneal lesions and the diagnostic value of AS-OCT in preventing unnecessary interventions.
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