Abstract
Purpose: Infectious keratitis remains a major cause of corneal morbidity and vision loss. While bacterial keratitis is commonly encountered, coexisting viral infections may complicate diagnosis and delay effective treatment. This case report highlights the importance of recognizing polymicrobial keratitis in patients with atypical or non-resolving clinical courses. Method: We describe the clinical course, diagnostic evaluation, and management of a 40-year-old female contact lens wearer who presented with a severe corneal ulcer initially presumed to be bacterial in origin. The patient was treated with intensive fortified topical antibiotics based on clinical suspicion of Pseudomonas aeruginosa infection related to prolonged contact lens use and poor lens hygiene. Due to incomplete clinical response, persistent epithelial defects, and disproportionately minimal pain, additional diagnostic testing was pursued. Results: Polymerase chain reaction testing confirmed concurrent herpes simplex virus type 1 infection. Management was adjusted to include targeted antiviral therapy in addition to continued antibacterial treatment and topical corticosteroids for inflammation control. An amniotic membrane transplant was performed to promote epithelial healing. The corneal infection stabilized with resolution of active inflammation; however, residual corneal scarring resulted in limited visual recovery. Conclusions: This case underscores the need to consider viral coinfection in cases of infectious keratitis that fail to respond as expected to standard antibacterial therapy. Early use of comprehensive microbiological and molecular diagnostics can facilitate timely identification of polymicrobial infections, allowing appropriate therapeutic modification and potentially improved visual outcomes.
Acknowledgements
The author gratefully acknowledges the patient for consenting to share this clinical case and the multidisciplinary medical team, including ophthalmologists, microbiologists, and nursing staff, for their contributions to patient care. Permission to acknowledge all named individuals has been obtained.
Recommended Citation
Alqahtani S. Coinfections in Infectious Keratitis: A Case Involving Herpes Simplex Virus (HSV) Type 1 Infection. The Internet Journal of Allied Health Sciences and Practice. 2026 Sep 01;24(3), Article 9.
