• Ming Zou, Yi Zhang, Xi Huang, Sheng Gao, and Chunling Liu.
• Department of Ophthalmology, West China Hospital of Sichuan University, ChengDu, Sichuan, China.
• Medicine (Baltimore). 2019 Jul 1; 98 (30): e16591.

RationaleEpithelial keratitis is a common complication after cataract surgery. Many factors have been attributed to this clinical phenomenon.Patient ConcernsAn 82-year-old woman without previous herpes simplex keratitis (HSK) underwent an uncomplicated clear corneal phacoemulsification procedure in the right eye. In the late postoperative period, epithelial keratitis developed in this same eye.DiagnosisAn initial diagnosis of HSK was made clinically. The lesion was refractory to antiviral treatment and had progressed. After topical acyclovir cessation and vigorous lubrication, a diagnosis of toxic keratitis was finally made.OutcomesThe corneal epithelial defect and dendritic lesion presented initially. Responding to antiviral treatment, this corneal lesion aggravated and revealed large epithelial erosion. After topical acyclovir cessation and initiation of vigorous lubrication, the toxic keratitis was completely resolved.LessonsEpithelial keratitis following cataract surgery is a common complication and can be misdiagnosed early in its disease course. Physicians should be alert to the possibility of HSK. Polymerase chain reaction detection is helpful in diagnosing this disease.

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