Herpes zoster ophthalmicus: Difference between revisions
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#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 | #*Treatment - [[acyclovir]] IV 10mg/kg q8hrs x7-10 days<ref>Wills Eye Manual, 6th edition</ref> | ||
#*OR [[famiciclovir]] PO | #*OR [[famiciclovir]] PO 500mg q8hrs x14 days | ||
#*OR [[valacyclovir]] PO 1g q8hrs | #*OR [[valacyclovir]] PO 1g q8hrs | ||
#Prevention of reactivation | #Prevention of reactivation | ||
#*[[Acyclovir]] PO | #*[[Acyclovir]] PO 500mg 5x per day | ||
#Ophtho consultation regarding steroid use | #Ophtho consultation regarding steroid use | ||
Revision as of 04:05, 19 July 2016
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 HA, 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
Diagnosis
- 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
- Acyclovir indicated for rash <1wk duration
- Treatment - acyclovir IV 10mg/kg q8hrs x7-10 days[2]
- OR famiciclovir PO 500mg q8hrs x14 days
- OR valacyclovir PO 1g q8hrs
- Prevention of reactivation
- Acyclovir PO 500mg 5x per day
- Ophtho consultation regarding steroid use