Inflammatory induced astigmatism: acute changes in corneal curvature secondary to marginal keratitis and previous mitomycin-C treatment

A 52-year-old man presented with left eye redness, blurred vision, and photophobia. Previous history included marginal keratitis and conjunctival squamous cell carcinoma treated with excision and topical MMC. Examination revealed current marginal keratitis, managed with topical antibiotic and corticosteroid. Regular assessments included high-resolution optical coherence corneal tomography, refraction, and blood tests to exclude other causes of peripheral infiltrate and thinning. Two weeks later visual acuity (VA) decreased and astigmatism increased. Significant refractive instability with astigmatism increased to 5.25 diopters with a corresponding decrease in VA. After 4 months of topical treatment, the marginal keratitis, astigmatism, and change in VA resolved. To the authors' knowledge, this is the first case report to describe an induced, and fluctuating high-magnitude corneal astigmatic change in response to marginal keratitis.