Late-onset Diffuse Lamellar Keratitis in the Context of Conjunctivitis Related to COVID-19: Case Report

Abstract

Purpose: To report a case of diffuse lamellar keratitis (DLK) occurring 23 years after laser in situ keratomileusis (LASIK), coinciding with a recent diagnosis of conjunctivitis related to coronavirus disease 2019 (COVID-19) . Methods: A 47-year-old woman had LASIK in 2000 and developed conjunctivitis related to COVID-19 in March 2022. In February 2023, she presented with 5 days of decreased vision (corrected distance visual acuity 20/25), photophobia, and glare in her right eye. She was diagnosed as having stage I DLK in the right eye based on corneal inflammatory infiltrates in the peripheral flap interface. Results: Topical steroids improved the patient's symptoms and resolved the inflammatory infiltrates within 2 months with a final corrected distance visual acuity of 20/20. Conclusions: This report describes a rare case of DLK occurring more than 20 years after LASIK. It is important to consider DLK even outside of the early postoperative period after LASIK or another lamellar interface–based procedure. In this case, conjunctivitis related to COVID-19 may have played a role in immune dysregulation and the development of DLK. [ Journal of Refractive Surgery Case Reports. 2024;4(1):e11–e14.]