Clearance of acute bilateral idiopathic central corneal stromal haze likely due to topical losartan

Introduction: To report the use of topical losartan as a potential treatment of acute bilateral central corneal stromal haze in a patient presenting with a syndrome resembling central toxic keratopathy (CTK). Patient and Clinical Findings: A 51-year-old man presented with clinically significant central corneal stromal haze bilaterally 6 days after a periorbital and facial contact dermatitis secondary to pesticide exposure. Uncorrected and corrected distance visual acuity (UDVA and CDVA) were 20/80 and 20/70 in the right eye, and 20/200− and 20/150+ in the left eye, respectively. After unsuccessful treatment with topical antivirals, antibiotics and corticosteroids, the patient started off-label treatment with topical losartan 0.8 mg/mL, administered 6 times per day. Diagnosis, Intervention, and Outcomes: 2 weeks after initiation, and 4 weeks from first presentation, UDVA and CDVA improved to 20/40 and 20/20 in the right eye, and 20/40 and 20/20 in the left eye. Complete resolution of corneal haze was observed at the slitlamp and anterior segment optical coherence tomography, and major corneal surface regularization could be seen on corneal tomography. Conclusions: Topical losartan, a transforming growth factor-β inhibitor, shows promise as a treatment for acute central corneal stromal haze secondary to a CTK-like syndrome. This clinical experience suggests that topical losartan may serve as a novel therapeutic option for such cases, but further clinical studies are needed to optimize dosages and treatment durations.