Herpes zoster ophthalmicus: Difference between revisions
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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== | ||
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**Cell and flare | **Cell and flare | ||
== | ==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 | |||
== | ==Disposition== | ||
==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
- 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
References
- ↑ Wills Eye Manual, 6th edition