Herpes Zoster Ophthalmicus
Infections with the varicella–zoster virus are more common in ophthalmology than Epstein- Barr virus and cytomegalovirus infections but less common than herpes simplex.
Varicella–zoster is another member of the herpes virus family (Herpesviridae). The virus causes two distinct clinical entities – varicella (chickenpox) and herpes zoster (shingles).
Chickenpox usually affects children under 15 years, while herpes zoster is primarily observed in adults. Adults can develop shingles upon contact with a child with chickenpox or as a result of various factors that compromise the immune system (infections, injury, intoxication, immunosuppressive agents). In some patients, herpes zoster may herald several devastating disorders, such as leukemia, lymphomatoid granulomatosis, cancer or AIDS.
The lesions usually appear along the trunk, between the ribs. However, in 10-15% of cases they develop in the periorbital area when the virus affects the trigeminal (Gasserian) ganglion and ophthalmic nerve (the first branch of the trigeminal nerve).
The most common symptoms of herpes zoster include acute neuralgia and blisters on the edematous red skin of the upper eyelid, forehead and scalp. The rash is always localized to one side and does not spread beyond the facial midline (photo).
Half of the patients with herpes zoster ophthalmicus develop viral infection the eye in 1-2 weeks (in this case, keratitis and anterior uveitis). The clinical presentation of keratitis varies from punctate and dendriform lesions to disciform keratouveitis.
Apart from keratitis, there are reports of varicella-zoster causing uveitis, isolated papillitis, granulomatous arteritis, short posterior ciliary artery vasculitis, optic neuritis, necrotizing retinitis, orbital apex syndrome, etc.
Rash, blisters and pain associated with the varicella-zoster virus infection are effectively managed with 3-4 subdermal injections of Poludan (200 units) in 10-15 ml of 0.5% Novocain into the affected area. External LEACKT is also highly effective against herpes zoster ophthalmicus.
