Anterior segment optical coherence tomography to differentiate adenoviral subepithelial infiltrates and scars

Subepithelial corneal infiltrates often follow adenoviral keratoconjunctivitis.[¹] They usually resolve over time, but in some, these can progress to permanent corneal scars. Anterior segment- optical coherence tomography (S-OCT) can be a very useful tool to differentiate reversible infiltrates from irreversible scars and obviates the need for a steroid trial.

Subepithelial corneal infiltrates [Fig. 1a] appear on AS-OCT patchy, anterior stromal hyperreflective lesions with an intact Bowman's membrane and a uniform epithelial thickness [Fig. 1b]. On the other hand, scars [Fig. 1c] on AS-OCT appear as hyperreflective plaque-like lesions in the anterior stroma with disruption of the Bowman's membrane and variable epithelial thickness due to epithelial remodeling [Fig. 1d].

Figure 1: (a) Subepithelial corneal infiltrates. (b) Patchy hyperreflective lesions involving the anterior stroma just beneath the intact Bowman's membrane. (c) Permanent adenoviral scars. (d) Hyperreflective plaque-like lesions in the anterior stroma with disruption of the Bowman's membrane and variable epithelial thickness

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