Unilateral corneal edema can present significant diagnostic challenges, especially in the absence of prior ocular trauma. This paper describes a case of a 40-year-old male patient with a foreign body sensation in the right eye, which had lasted several weeks. Initial examination revealed unilateral reduction in visual acuity and a hazy cornea with increased central corneal thickness. A foreign body was removed, and empirical ofloxacin treatment was administered for suspected bacterial keratitis secondary to trauma. However, the lack of sufficient clinical improvement after the implemented treatment prompted consideration of other potential diagnoses.
A detailed assessment, including imaging studies, led to a differential diagnosis that included iridocorneal endothelial (ICE) syndrome, corneal dystrophy, and herpes simplex keratitis (HSK). ICE syndrome was initially considered the leading diagnosis, due to the presence of unilateral corneal edema and endothelial decompensation. However, the diagnosis of HSK was supported by the patient’s significant improvement following oral acyclovir and topical dexamethasone administration, which resulted in reduced central corneal edema and improved visual acuity. Given the therapeutic response, ICE syndrome was considered to be less likely, though its potential interaction with HSK remains an area of investigation.
This report presents a case of unilateral corneal edema and discusses its clinical features and differential diagnosis.