Keratoconjunctivitis by confocal microscopy after topical cyclosporine

AIM: To describe the observations obtained by confocal microscopy concerning corneal stromal structure in the process of adenoviral epidemic keratoconjunctivitis, from the onset of the disease up to 20 weeks of follow-up, after topical cyclosporine. METHODS: A 16-years-old boy has developed subepithelial infiltrates and an epidemic keratoconjunctivitis from adenovirus in both eyes. Clinical case was analyzed by confocal microscopy (40x mode, Nidek ConfoScan 4) before and after administration of topical cyclosporine. RESULTS: Two weeks after the onset of the symptoms, corneal stroma showed the presence of cells with highly reflective area. These cells, comparable to keratocytes, had a typical fusiform shape and assumed a particular rosette disposition, never highlighted in the literature. Hyperreflective areas disappeared in both eyes after administration of topical cyclosporine 1% for 30 days. This outcome was also confirmed after five months. CONCLUSION: The confocal microscopy performed on the surface of the stroma before and after treatment with cyclosporine suggests the presence of a localized immune activation in subepithelial layer.