Bell's palsy with Herpes simplex disciform keratitis: A case report

PURPOSE: To report a novel case of unilateral peripheral facial nerve palsy manifesting as a complication of Herpes simplex keratitis. OBSERVATIONS: A 51-year-old immunocompetent male presented with severe eye pain for 3 weeks. He was found to have Herpes simplex keratitis in the left eye and started on valacyclovir 3g per day for 10 days. At three weeks his pain and blurred vision resolved. He returned 2.5 months later with worsening of vision and five days of unilateral facial numbness and weakness. Ocular evaluation revealed a visual acuity of 20/25 in the left eye, which showed mid-stromal corneal edema bordered by several keratoprecipitates. Both the keratitis and Bell's palsy markedly improved with valacyclovir, topical prednisolone, and a 10-day course of oral prednisone. CONCLUSIONS AND IMPORTANCE: This is the first reported case of Bell's palsy accompanying disciform keratitis. Both entities have been observed to be caused by Herpes simplex, however they have not been described together in one patient. Knowledge that these conditions may present simultaneously allows for earlier identification and treatment, resulting in decreased morbidity.