Herpes zoster ophthalmicus: Difference between revisions
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==Background== | ==Background== | ||
*Occurs when VZV is reactivated in the ophthalmic division (V1) of trigeminal nerve | *Occurs when [[VZV]] 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) | ||
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*Slit-lamp exam: | *Slit-lamp exam: | ||
**Pseudodendrite (poorly staining mucous plaque w/ no epithelial erosion | **Pseudodendrite (poorly staining mucous plaque w/ no epithelial erosion | ||
***In contrast to HSV which has true dendrite w/ epithelial erosion and staining | ***In contrast to [[HSV]] which has true dendrite w/ epithelial erosion and staining | ||
**Cell and flare | **Cell and flare | ||
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#Cool compresses/lubrication drops | #Cool compresses/lubrication drops | ||
#Topical antibiotics to skin to prevent secondary infection | #Topical antibiotics to skin to prevent secondary infection | ||
#Acyclovir indicated for rash <1wk duration | #[[Acyclovir]] indicated for rash <1wk duration | ||
#*Treatment - acyclovir IV 10 mg/kg q8hrs x7-10 days<ref>Wills Eye Manual, 6th edition</ref> | #*Treatment - [[acyclovir]] IV 10 mg/kg q8hrs x7-10 days<ref>Wills Eye Manual, 6th edition</ref> | ||
#*OR famiciclovir PO 500 mg q8hrs x14 days | #*OR [[famiciclovir]] PO 500 mg q8hrs x14 days | ||
#*OR valacyclovir PO 1g q8hrs | #*OR [[valacyclovir]] PO 1g q8hrs | ||
#Prevention of reactivation | #Prevention of reactivation | ||
#*Acyclovir PO 500 mg 5x per day | #*[[Acyclovir]] PO 500 mg 5x per day | ||
#Ophtho consultation regarding steroid use | #Ophtho consultation regarding steroid use | ||
==Disposition== | ==Disposition== | ||
==See Also== | |||
*[[Herpes zoster oticus]] | |||
==References== | ==References== | ||
Revision as of 03:55, 27 July 2015
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, 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