Herpes zoster ophthalmicus: Difference between revisions
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==Background== | ==Background== | ||
*Occurs when [[ | *Occurs when [[varicella zoster virus]] is reactivated in the ophthalmic division (V1) of trigeminal nerve | ||
*50% of cases associated with ocular involvement | *50% of cases associated with ocular involvement | ||
**Highly suggested by vesicles at tip of nose (Hutchinson's sign) | **Highly suggested by vesicles at tip of nose (Hutchinson's sign) | ||
Revision as of 03:56, 27 July 2015
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 pts <40yrs
Clinical Features
- Prodrome of HA, malaise, photophobia, fever
- Unilateral pain or hypesthesia in V1 distribution
- Hyperemic conjunctivitis, episcleritis, lid droop
Differential Diagnosis
Conjunctivitis Types
Diagnosis
- Zoster in distribution of V1
- Slit-lamp exam:
- Pseudodendrite (poorly staining mucous plaque w/ no epithelial erosion
- In contrast to HSV which has true dendrite w/ epithelial erosion and staining
- Cell and flare
- Pseudodendrite (poorly staining mucous plaque w/ no epithelial erosion
Treatment
- Cool compresses/lubrication drops
- Topical antibiotics to skin to prevent secondary infection
- Acyclovir indicated for rash <1wk duration
- Treatment - acyclovir IV 10 mg/kg q8hrs x7-10 days[1]
- OR famiciclovir PO 500 mg q8hrs x14 days
- OR valacyclovir PO 1g q8hrs
- Prevention of reactivation
- Acyclovir PO 500 mg 5x per day
- Ophtho consultation regarding steroid use
Disposition
See Also
References
- ↑ Wills Eye Manual, 6th edition