Demonstration of "owl's eye" morphology by confocal microscopy in a patient with presumed cytomegalovirus corneal endotheliitis

Am J Ophthalmol. 2007 Apr;143(4):715-7. doi: 10.1016/j.ajo.2006.11.026. Epub 2006 Dec 19.


Purpose: To report confocal microscopic observations of characteristic corneal endothelial lesions in a patient with presumed cytomegalovirus (CMV) corneal endotheliitis.

Design: Case report.

Methods: A 77-year-old, immunocompetent man was admitted with corneal edema, keratic precipitates, and coin-shaped lesions in the right eye. Confocal microscopy was performed to examine the corneal endothelium. Polymerase chain reaction (PCR) was used to identify viral DNA in an aqueous humor sample.

Results: CMV DNA was detected by PCR. Confocal microscopy showed large corneal endothelial cells with an area of high reflection in the nucleus surrounded by a halo of low reflection. This "owl's eye" morphology is characteristic of CMV infection. Topical and intravenous ganciclovir treatment resulted in rapid resolution of the corneal precipitates and edema, followed by disappearance of the owl's eye morphology.

Conclusions: Confocal microscopy can detect the owl's eye morphology in the corneal endothelium of patients with presumed CMV corneal endotheliitis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antiviral Agents / therapeutic use
  • Aqueous Humor / virology
  • Cytomegalovirus / genetics
  • Cytomegalovirus / isolation & purification
  • Cytomegalovirus Infections / diagnosis*
  • Cytomegalovirus Infections / drug therapy
  • Cytomegalovirus Infections / virology
  • DNA, Viral / analysis
  • Endothelium, Corneal / pathology*
  • Eye Infections, Viral / diagnosis*
  • Eye Infections, Viral / drug therapy
  • Eye Infections, Viral / virology
  • Ganciclovir / therapeutic use
  • Humans
  • Keratitis / diagnosis*
  • Keratitis / drug therapy
  • Keratitis / virology
  • Male
  • Microscopy, Confocal*
  • Polymerase Chain Reaction


  • Antiviral Agents
  • DNA, Viral
  • Ganciclovir