Bilateral Sequential Herpes Simplex Type 2 Panophthalmitis in an Adult with a Toll-Like Receptor 4 Mutation

HSV-2 panophthalmitis is rare and visually destructive, and we present the first reported case of bilateral disease. We hypothesise that TLR-4 mutation, not previously reported in association with HSV ocular inflammation, may have contributed to excessive inflammation and severe ocular damage. We suggest comprehensive immunological evaluation in all patients with severe viral intraocular inflammation. Prompt diagnosis with PCR and immediate high-dose antiviral therapy is critical and immune abnormality may require amended management.