Background: There are conflicting reports on the role of hepatitis C virus in corneal pathology.
Patient: A 58-year-old male patient presented with recurrent peripheral corneal ulcers and corneal thinning in the left eye. There was a bilateral vascular pannus formation and a decreased ocular wetting measured by Schirmer testing. The posterior ocular segment was normal. There was no sign of any systemic rheumatic disease. Serological testing detected antibodies against hepatitis C virus. Hepatitis C virus RNA testing using a quantitative polymerase chain reaction method revealed hepatitis C virus RNA in serum (> 3.2 million copies/ml) and in tear samples (18,000 copies/ml) of the patient. In a control group of 7 consecutive patients with hepatitis C virus RNA detection in the serum but without ocular pathology, no hepatitis C virus RNA was detected in tear samples (detection limit: 1000 copies/ml).
Conclusions: Detection of hepatitis C virus RNA in lacrimal fluid of a patient with recurrent peripheral corneal ulcers may indicate a pathogenic role of hepatitis C virus in corneal pathology. Especially, since our patients with systemic hepatitis C virus infection but without ocular changes did not show hepatitis C virus RNA in their tears. Therefore, patients with recurrent corneal ulcers of unknown origin should be tested for systemic hepatitis C virus infection.