Herpes zoster ophthalmicus: Difference between revisions

No edit summary
No edit summary
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*Unilateral pain or hypesthesia in V1 distribution
*Unilateral pain or hypesthesia in V1 distribution
*Hyperemic conjunctivitis, episcleritis, lid droop
*Hyperemic conjunctivitis, episcleritis, lid droop
==Differential Diagnosis==
{{Conjunctivitis DDX}}


==Diagnosis==
==Diagnosis==
Line 17: Line 20:
**Cell and flare
**Cell and flare


==Differential Diagnosis==
==Treatment==
{{Conjunctivitis DDX}}
#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


==Treatment==
==Disposition==
*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==

Revision as of 15:40, 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

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

Treatment

  1. Cool compresses/lubrication drops
  2. Topical antibiotics to skin to prevent secondary infection
  3. 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
  4. Prevention of reactivation
    • Acyclovir PO 500 mg 5x per day
  5. Ophtho consultation regarding steroid use

Disposition

References

  1. Wills Eye Manual, 6th edition