Herpes zoster ophthalmicus: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Prodrome of headache, malaise, photophobia, fever | *Prodrome of [[headache]], malaise, photophobia, [[fever]] | ||
*Unilateral pain or hypesthesia in V1 distribution | *Unilateral [[eye pain|pain]] or hypesthesia in V1 distribution | ||
*Hyperemic conjunctivitis, episcleritis, lid droop | *Hyperemic [[conjunctivitis]], [[episcleritis]], lid droop | ||
*Vesicular [[rash]] in V1 distribution | |||
*[[Slit-lamp exam]]: | |||
**Pseudodendrite (poorly staining mucous plaque with no epithelial erosion | |||
***In contrast to [[HSV]] which has true dendrite with epithelial erosion and staining | |||
**Cell and flare | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Conjunctivitis DDX}} | {{Conjunctivitis DDX}} | ||
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==Evaluation== | ==Evaluation== | ||
* | *Clinical | ||
==Management== | ==Management== | ||
*Cool compresses/lubrication drops | *Cool compresses/lubrication drops | ||
*Topical antibiotics to skin to prevent secondary infection | *Topical [[antibiotics]] to skin to prevent secondary infection | ||
*Antiviral therapy indicated for rash <1wk duration | *Antiviral therapy indicated for rash <1wk duration | ||
**[[Acyclovir]] IV 10mg/kg q8hrs x7-10 days<ref>Wills Eye Manual, 6th edition</ref> '''OR''' | **[[Acyclovir]] IV 10mg/kg q8hrs x7-10 days<ref>Wills Eye Manual, 6th edition</ref> '''OR''' | ||
**[[ | **[[Famciclovir]] 500mg PO q8hrs x14 days '''OR''' | ||
**[[Valacyclovir]] 1g PO q8hrs | **[[Valacyclovir]] 1g PO q8hrs | ||
*Prevention of reactivation | *Prevention of reactivation | ||
Revision as of 16:58, 5 October 2019
Background
- Occurs when varicella zoster virus is reactivated in the ophthalmic division (V1) of trigeminal nerve
- 50% of cases associated with ocular involvement
- Highly suggested by vesicles at tip of nose (Hutchinson's sign)
- Nasociliary branch of V1 innervates both the lateral/tip of nose as well as the cornea
- Consider immunocompromise in patients <40yrs
Clinical Features
- Prodrome of headache, malaise, photophobia, fever
- Unilateral pain or hypesthesia in V1 distribution
- Hyperemic conjunctivitis, episcleritis, lid droop
- Vesicular rash in V1 distribution
- Slit-lamp exam:
- Pseudodendrite (poorly staining mucous plaque with no epithelial erosion
- In contrast to HSV which has true dendrite with epithelial erosion and staining
- Cell and flare
- Pseudodendrite (poorly staining mucous plaque with no epithelial erosion
Differential Diagnosis
Conjunctivitis Types
Varicella zoster virus
- Varicella (Chickenpox)
- Herpes zoster (Shingles)
- Herpes zoster ophthalmicus
- Herpes zoster oticus (Ramsay Hunt syndrome)
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Ophthalmologic complications
- Other
- HAART medication side effects[1]
- HAART-induced lactic acidosis
- Neuropyschiatric effects
- Hepatic toxicity
- Renal toxicity
- Steven-Johnson's
- Cytopenias
- GI symptoms
- Endocrine abnormalities
Evaluation
- Clinical
Management
- Cool compresses/lubrication drops
- Topical antibiotics to skin to prevent secondary infection
- Antiviral therapy indicated for rash <1wk duration
- Acyclovir IV 10mg/kg q8hrs x7-10 days[2] OR
- Famciclovir 500mg PO q8hrs x14 days OR
- Valacyclovir 1g PO q8hrs
- Prevention of reactivation
- Acyclovir PO 500mg 5x per day
- Ophtho consultation regarding steroid use