Herpes zoster ophthalmicus: Difference between revisions

Revision as of 00:47, 26 October 2011

Background

Occurs when VZV 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 fever
Unilateral pain or hypesthesia in V1 distribution
Hyperemic conjunctivitis, episcleritis, lid droop

Diagnosis

Zoster in distribution of V1
Slit-lamp exam:
1. Pseudodendrite (poorly staining mucous plaque w/ no epithelial erosion
  1. In contrast to HSV whic hhas true dendrite w/ epithelial erosion and staining
2. Cell and flare

Treatment

1. Cool compresses/lubrication drops
2. Topical antibiotics to skin to prevent secondary infection
3. Acyclovir
  1. Indicated for rash <1wk duration
  2. 800mg 5x/day x 7-10d
4. Ophtho consultation regarding steroid use

Source

UpToDate
Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Herpes zoster (HZV) ophthalmicus
+*Occurs when VZV is reactivated in the ophthalmic division (V1) of trigeminal nerve
-*Occurs when the varicella-zoster virus is reactivated in the ophthalmic division of the trigeminal nerve
+*50% of cases associated with ocular involvement
-*10-25% of all zoster cases
+**Highly suggested by vesicles at tip of nose (Hutchinson's sign)
-*Most cases involve skin only, but serious ocular involvement can occur (if involves nasociliary branch)
+*Consider immunocompromise in pts <40yrs
-**Hutchinson’s sign = pustules at tip of the nose
-***Mild specificity for ocular involvement
+==Clinical Features==
-***NOT sensitive for ocular involvement
+#Prodrome of HA, malaise fever
+#Unilateral pain or hypesthesia in V1 distribution
+#Hyperemic conjunctivitis, episcleritis, lid droop
 ==Diagnosis==
-#Rash in distribution
+#Zoster in distribution of V1
-#If corneal invovement
+#Slit-lamp exam:
-##Corneal dedrite  on fluorescein stain
+##Pseudodendrite (poorly staining mucous plaque w/ no epithelial erosion
-###Appear branching or ‘‘medusa-like’’ pattern with tapered ends
+###In contrast to HSV whic hhas true dendrite w/ epithelial erosion and staining
-####In contrast to HSV dendrites, which have terminal bulbs
+##Cell and flare
 ==Treatment==
-#No corneal involvement
-##Topical antibiotics may prevent secondary infection
 ##Cool compresses/lubrication drops
-##Ophtho followup (within 24hrs if any ocular involvement)
+##Topical antibiotics to skin to prevent secondary infection
-#Corneal involvement
+##Acyclovir
-##Artificial tears (preservative-free) Q1-2 hrs
+###Indicated for rash <1wk duration
-##Ocular lubricant ointment QHS
+###800mg 5x/day x 7-10d
-##Consult ophtho regarding
+##Ophtho consultation regarding steroid use
-###Systemic or topical antiviral agents
-###Topical steroids (caution; only in consultation)
 ==Source==
+*UpToDate
+*Tintinalli
 [[Category:ID]]
 [[Category:Ophtho]]