Nummular Keratitis Following Epidemic Keratoconjunctivitis: A Guide to Managing Subepithelial Infiltrates

Introduction: Epidemic keratoconjunctivitis (EKC) is a highly contagious viral ocular surface infection characterized by conjunctivitis with corneal involvement. Although EKC is usually self-limiting, corneal sequelae can persist for weeks to months and may significantly impact the quality of life. Aim: To analyze the effectiveness of the treatment protocol and healing of nummular keratitis after EKC. Methods: This is a retrospective observational study of eight patients with a history of viral conjunctivitis and EKC. Diagnosis and management in the acute stage relied solely on clinical evaluation, as laboratory testing remains significantly limited, often resulting in underdiagnosis and inadequate treatment. Thorough slit lamp evaluation, fluorescein staining, and visual acuity assessment were performed for all patients during follow-up. These cases of EKC were initially managed suboptimally elsewhere and later presented with decreased vision, photophobia, and nummular subepithelial infiltrates. Results: All patients were treated with a tapering course of low-dose topical corticosteroids, leading to complete resolution in six cases (75%), while two (25%) required long-term topical cyclosporine therapy. Conclusion: This study highlights the importance of close monitoring of patients with acute infectious conjunctivitis until full resolution, enabling timely initiation of topical immunosuppressive therapy when indicated for nummular subepithelial infiltrates. Our study suggests that treatment and follow-up protocols, along with screening for other household contacts with conjunctivitis, can significantly reduce the severity and duration of EKC and help preserve final visual acuity after resolution.