Clinical significance of owl eye morphologic features by in vivo laser confocal microscopy in patients with cytomegalovirus corneal endotheliitis

Am J Ophthalmol. 2012 Mar;153(3):445-53. doi: 10.1016/j.ajo.2011.07.026. Epub 2011 Oct 25.


Objective: To demonstrate the clinical significance of owl eye morphologic features observed by in vivo laser confocal microscopy in patients with cytomegalovirus (CMV) corneal endotheliitis.

Design: Observational case series.

Methods: participants: Six eyes of 6 patients (6 men; mean age, 73.3 years) with cytomegalovirus corneal endotheliitis diagnosed by clinical manifestations together with polymerase chain reaction from aqueous humor samples. intervention: All patients were examined by slit-lamp biomicroscopy and in vivo laser confocal microscopy. main outcome measures: Clinical manifestations were summarized by reviewing medical records. Selected confocal images of corneal layers were evaluated qualitatively for shape and degree of light reflection of abnormal cells and deposits.

Results: All patients had long histories of anterior uveitis with intraocular pressure elevation, corneal edema with keratic precipitates, and decrease of endothelial cell densities. Coin-shaped lesions were observed by slit lamp only in 1 patient at the first visit and in 2 additional patients at subsequent follow-up. In all patients, confocal microscopy demonstrated reduced subepithelial nerves, subepithelial opacity, increased reflectivity of keratocytes, highly reflective dots, and needle-shaped bodies. Owl eye morphologic features were observed consistently in all patients at the initial visit, and highly reflective round bodies were detected in 5 patients; most notably, these confocal features were reversible after resolution of endotheliitis.

Conclusions: Owl eye morphologic features and highly reflective round bodies observed by confocal microscopy may be useful as an adjunct for the noninvasive diagnosis of cytomegalovirus corneal endotheliitis. Reversibility of these features after resolution of endotheliitis may be useful for monitoring the therapeutic effects without multiple anterior chamber tap.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • Aqueous Humor / virology
  • Corneal Edema / diagnosis
  • Corneal Stroma / innervation
  • 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
  • Follow-Up Studies
  • Ganciclovir / therapeutic use
  • Glaucoma / diagnosis
  • Glaucoma / drug therapy
  • Humans
  • Keratitis / diagnosis*
  • Keratitis / drug therapy
  • Keratitis / virology
  • Male
  • Microscopy, Confocal
  • Middle Aged
  • Ophthalmic Nerve / pathology
  • Polymerase Chain Reaction
  • Uveitis, Anterior / diagnosis


  • Antihypertensive Agents
  • Antiviral Agents
  • DNA, Viral
  • Ganciclovir