Three case reports from EURETINA 2026 reveal that herpesviruses can trigger serious eye complications in unexpected settings — including after routine cataract surgery and dexamethasone implants — even in immunocompetent patients. Clinicians are urged to broaden their diagnostic lens, take detailed patient histories, and consider antiviral therapy early when ocular inflammation doesn't follow the expected script.
Three striking case reports presented at EURETINA 2026 highlight how herpesviruses can lurk behind ocular conditions that clinicians might not initially suspect. In two cases from Spain, immunocompetent patients developed intraocular herpesvirus complications — including uveitis, vitritis, and retinal necrosis — following slow-release dexamethasone implants. Both responded to antiviral therapy, but the cases underscore how localized immunosuppression from these implants may reactivate latent herpes infections even in otherwise healthy individuals.
A case from Brazil added another twist: a 68-year-old woman with multiple myeloma developed acute herpes zoster endophthalmitis just 36 hours after routine cataract surgery. The key diagnostic clue? A household member had recently been treated for herpes zoster. Vitrectomy and systemic antivirals preserved her vision. Meanwhile, a Greek case showed that HSV-1/2 infection may have triggered Behçet-spectrum autoimmune uveitis in a 31-year-old man, who ultimately required methotrexate and adalimumab after repeatedly relapsing when steroids were tapered.
Key Takeaways:
Why it matters: These cases remind clinicians that herpesviruses are versatile and unpredictable — capable of mimicking other conditions, exploiting localized immunosuppression, and even triggering autoimmune cascades. Early suspicion and targeted antiviral therapy can be vision-saving.
