Objective (Aim): The article is a case report of a very rare case of bilateral herpes simplex virus infection associated with bilateral necrotizing scleritis with scleral melt in an elderly north Indian female of lower middle socioeconomic status. Methods: A 65-year-old female presented to our clinic with a wide variety of presentations ranging initially from neurotropic corneal ulcer to necrotizing scleritis with scleral melt for 2 years. The patient records were evaluated and computed. A PubMed literature search on herpes scleritis was conducted and reviewed. Results: A keen sense of judgment, timely management, and patient counseling are crucial for a rapid and favorable outcome. Conclusions: Bilateral necrotizing scleritis with scleral melt can be a rare atypical presentation of herpes simplex keratitis. In such atypical cases, diagnosis may be challenging. Associated clinical findings, history of herpes keratitis, which may be recurrent, and response to antiviral drugs, may give clues towards the diagnosis in such atypical cases. In addition to this, surgical intervention should not be delayed if it seems inevitable. Abbreviations: RE = right eye, LE = left eye, BCL = bandage contact lens, KP = keratic precipitate, mm = millimeter, mg = milligram.
Keywords: bilateral; herpes simplex keratitis; necrotizing scleritis; scleral melt.
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