An Unusual Clinical Presentation of New-Onset Herpetic Necrotizing Sclerokeratitis After Implantable Collamer Lens Surgery: A Case Report

We report a case of atypical new-onset herpetic necrotizing sclerokeratitis after implantable collamer lens surgery. A 37-year-old healthy Saudi female, known to have keratoconus underwent keratoplasty 14 years ago, followed by implantable collamer lens surgery (ICL) for visual rehabilitation nine months ago in the left eye. She presented to our institute with a history of subacute painful ocular pain and redness in her left eye over seven months. Upon assessment, the left eye's visual acuity was 20/200. Examination of the anterior segment showed injected conjunctiva, episcleral and scleral blood vessels, scleral thinning associated with peripheral keratitis, keratic precipitates, and decreased corneal sensation. Diagnostic ultrasonography (B-scan) revealed mild vitreous opacities with a normal optic nerve head and no retinal choroidal thickening. The results of the right eye examination were unremarkable. The patient was found to have atypical herpetic necrotizing sclerokeratitis and was treated with topical and oral antivirals for three months, with significant improvement. Thus, timely detection and treatment were crucial for minimizing vision-threatening complications.