Spectrum of herpetic eye disease during COVID-19 pandemic

Purpose: To analyze clinical presentation, outcome and upsurge in the acute presentation of Herpetic eye disease (Herpes simplex keratits and Herpes Zoster Ophthalmicus) cases during coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Retrospective analysis of case records of patients diagnosed with either acute HSV or HZO from April 2020 to March 2021 for demography, ocular manifestations, and management and clinical outcome was done. Results: We had 71 patients presenting to our hospital with herpetic eye disease with 50.70% being HZO. The majority (64.78%) of the patients were <50 years of age. The mean time to presentation from the onset of symptoms was earlier in HZO compared to HSV. Three patients were post-COVID-19 infection while six patients were post-COVID-19 vaccination. Stromal keratitis (48.5%) was the most common presentation in patients with HSV while keratitis and uveitis (31.57% each) were the most common presentation in HZO. 83.08% resolved without any visual sequelae. We also observed atypical presentation in the form of multidermatomal involvement and recurrence of keratitis in HZO patients. We observed an alarming two-fold increase in the number of cases that presented this year (2020–21) as compared to the same time (n = 33) in the past year (2019–20). Conclusion: This study highlights an increase in viral eye disease presenting atypically and higher incidence in young individuals during the COVID pandemic. Viral disease of the eye during the pandemic may be related to the altered immunity in coexisting asymptomatic COVID-19-infected patients and similar in postvaccinated individuals or the stress-induced immune alteration by the pandemic itself in healthy individuals. However, though this study suggests direct causal relation of either of the above as possibility and needs to be kept in mind in clinical practice, for definite association, we need further exploration and more data.