Presumed Ocular Vaccinia

Saw a patient with nasty unilateral Herpes-looking disciform keratitis that recurs every 6 months or so. It started a few years back right after he got vaccinated for the H1N1 virus. His ulcer is unresponsive to any of the anti-viral agents available - viroptic, acyclovir, zirgan, etc. After consult with an ophthalmologist, we put him on steroids, and it made it a little better. He is 20/400 in the affected eye when the ulcer is active, and has residual vision loss even after it goes away on its own temporarily.

I did some reading, and found something on ocular vaccinia (you can even find it in Will's). Turns out that after receiving a viral vaccine, you can spread the virus to your eye for up to three weeks afterward if you touch the injection site, then rub your eye. Looks like that's what happened to this guy, but it never responds to medication.