Clinical Manifestations and Characteristics of In Vivo Confocal Microscopy in Varicella Zoster Virus-Related Corneal Endotheliitis.

Objective: To explore the clinical characteristics and in vivo confocal microscopic (IVCM) findings of varicella zoster virus (VZV)-related corneal endotheliitis.Methods: Retrospectively reviewed 20 eyes with corneal edema which were diagnosed by real-time polymerase chain reaction.Results: one had VZV infection. Three had epithelial lesions. Six had mydriasis. Four had loss of iris pigment. Keratic precipitates (KPs) were mixed. Subbasal nerves had disappeared in 12 eyes. Langerhans cells were observed in seven eyes. The deviations in endothelial cell layers consisted of guttate (n = 1), enlarged intercellular gaps (n = 11), infiltration of inflammatory cells (n = 8), loss of defined cell boundaries (n = 1) and anomalous nucleus (n = 9). The shape of KPs in IVCM included type I (n = 6), type III (n = 3) and type IV (n = 4).Conclusion: VZV-related corneal endotheliitis is remarkably difficult to detect clinically. Most cases have no typical skin lesions. The typical clinical feature is that of segmental iris atrophy and mixed KPs.