Herpes zoster ophthalmicus: Difference between revisions
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==Management== | ==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<ref>Wills Eye Manual, 6th edition</ref> '''OR''' | |||
**[[Famiciclovir]] 500mg PO q8hrs x14 days '''OR''' | |||
**[[Valacyclovir]] 1g PO q8hrs | |||
*Prevention of reactivation | |||
**[[Acyclovir]] PO 500mg 5x per day | |||
*Ophtho consultation regarding steroid use | |||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
Revision as of 03:43, 31 July 2017
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)
- 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
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
- Zoster in distribution of V1
- 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
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
- Famiciclovir 500mg PO q8hrs x14 days OR
- Valacyclovir 1g PO q8hrs
- Prevention of reactivation
- Acyclovir PO 500mg 5x per day
- Ophtho consultation regarding steroid use