A 40 year female (homemaker)presented with complaints of diminution of vision redness and watering from her right eye since last 2 weeks. There was no significant contributory history of trauma, foreign body, contact lens wear, use of home remedies or any eye surgeries in the past.
On examination on slit lamp her right eye (RE) showed a raised corneal epithelial lesion in a dendritic pattern in superior part of cornea with mild anterior chamber flare; rest findings were normal in RE. LE showed no abnormal findings.
Clinically diagnosing it as herpes simplex viral lesion (dendritic ulcer) topical antiviral eye ointment was started 5times a day along with cycloplegic homatropine eye drops. After 5 days of follow up, cornea showed a similar raised epithelial lesion with dendritic appearance on nasal side of cornea, with disappearance of previous lesion, patient’s symptoms persisted and she did not tolerate acyclovir ointment well. Therefore, the frequency of acyclovir ointment was reduced to 2 times a day and a steroid – antibiotic eye drop was added to the treatment.
On the next follow up after 5 days patient’s cornea showed again the migration of raised epithelial lesion to superior part of the corneal periphery with still reduced vision and mild reduction in her symptoms.
We reviewed the literature thoroughly and the diagnosis of migratory serpiginous corneal epitheliopathy(MSCE ) was made.
MSCE is a rare entity affecting younger individuals between 3 to 4 decades with unknown etiology and usually takes several months to heal.
Plan of management was changed, the antivirals were stopped completely, and the patient was shifted to frequent instillation of artificial tears drops (every 2-3 hours). After 2 months of the treatment patient’s cornea cleared off with no epithelial lesions or erosions. Vision also showed markable improvement.
MSCE Is a unilateral condition affecting young individuals and is characterised by araised epithelium in various geographical shapes regressing centripetally in amoeboid pattern. Although definitive cause couldn't be ascertained the lesion showed good clinical response to frequent instillation of artificial tear drops in 2 to 3 months.
The name MSCE is termed thus for 3 reasons: the lesions were,
- Migratory on every presentation
- Serpiginous in appearance
- Were confined to corneal epithelium.
