Herpes zoster ophthalmicus: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Prodrome of HA, malaise, photophobia, fever | |||
*Unilateral pain or hypesthesia in V1 distribution | |||
*Hyperemic conjunctivitis, episcleritis, lid droop | |||
==Diagnosis== | ==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 | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Treatment== | ==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<ref>Wills Eye Manual, 6th edition</ref> | |||
**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 | |||
==References== | |||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revision as of 15:39, 9 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
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
Differential Diagnosis
Conjunctivitis Types
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
References
- ↑ Wills Eye Manual, 6th edition