A new variant of herpetic epithelial keratitis?

Researchers in France recently described an atypical form of superficial herpetic epithelial keratitis which they termed archipelago keratitis because it is composed of several small foci of corneal ulcerations disposed in a radial centripetal fashion originating from the limbus. They conclude that archipelago keratitis may represent a distinct form of recurrent herpetic epithelial keratitis.

All six patients described had a past history of herpetic epithelial keratitis, herpetic vesicles on the ipsilateral lid or both. Polymerase chain reaction-based screening for herpes simplex virus 1 and 2 in corneal scrapings demonstrated positive results in two patients. In vivo corneal confocal microscopy revealed focal areas of hyperreflective epithelial cells and hyperreflective subepithelial dendritic structures overlying activated keratocytes. All the patients improved with oral valacyclovir treatment followed by topical steroid therapy.

Researchers suspect archipelago keratitis may arise from centripetal progression of marginal herpetic epithelial keratitis. This clinical pattern may be the result of the migration of limbal stem cells across the herpetic epithelial keratitis marginal ulcer, resulting in herpetic epithelial keratitis dissemination toward the center of the cornea.