Atypical clinical presentation of HSV-1 keratouveitis after phacoemulsification cataract surgery with no history of herpetic ocular infection: case report

Introduction: Recurrence of ocular herpes is very common and often associated with various triggers such as stress, immunosuppression, and ocular surgery. Although herpes simplex virus (HSV) reactivation after cataract surgery has been reported in patients with history of herpetic disease, its occurrence in patients without a known history is uncommon. Patient and Clinical Findings: A case of herpetic keratouveitis occurring shortly after phacoemulsification cataract surgery in an immunocompetent woman with no ocular herpes history is reported. Initial postoperative recovery was uneventful, but the patient developed worsening visual acuity, ocular pain, and anterior chamber inflammation. Diagnosis, Interventions, and Outcomes: Differential diagnoses including toxic anterior segment syndrome, retained lens material, and endophthalmitis were ruled out based on clinical features and imaging. Polymerase chain reaction testing of the aqueous humor confirmed HSV-1 infection. Antiviral treatment with oral valacyclovir was initiated and led to rapid resolution of inflammation and full visual recovery. Conclusions: This case highlights the possibility of HSV reactivation with atypical clinical features and prolonged postoperative inflammation after cataract surgery in patients without a history of ocular herpes.