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Confocal Microscopy of Subepithelial Infiltrates Occurring After Epidemic Keratoconjunctivitis

Alsuhaibani, Adel H MD*; Sutphin, John E MD; Wagoner, Michael D MD*

doi: 10.1097/01.ico.0000220773.04155.7a
Clinical Science

Purpose: To describe the confocal microscopic findings in subepithelial infiltrates (SEIs) associated with epidemic keratoconjunctivitis (EKC).

Methods: Observational case report.

Results: A 14-year-old Saudi girl with keratoconus developed SEIs after the onset of bilateral EKC. Confocal microscopy of the left cornea 8 weeks after the onset of EKC showed many highly reflective dendritic cells at the level of basal epithelium, epithelial basement membrane zone, and anterior stroma, as well as many highly reflective fusiform and round cells within the anterior stroma, with decreasing density in progressively deeper layers of the stroma. These findings were not present on confocal microscopy that had been performed 2 weeks before the onset of EKC.

Conclusion: Confocal microscopic examination of SEIs after EKC provides evidence of an inflammatory response localized to the basal epithelium and anterior stroma of the central cornea.

From the *Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; and the †Cornea and External Disease Service, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA.

Received for publication April 8, 2005; revision received December 1, 2005; accepted December 10, 2005.

The authors state that they have no proprietary interest in the products named in this article.

Reprints: Michael D. Wagoner, MD, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh 11462, Saudi Arabia (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.