Herpes Zoster Ophthalmicus
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Occurs when Varicella Zoster Virus reactivates in the trigeminal ganglion and passes down the ophthalmic division of the trigeminal nerve.
Clinical presentation
- Presents with painful vesicular rash in the trigeminal V1 area –vesicles on the tip of the nose indicate nasociliary branch involvement and increases the risk of ocular involvement
- Some patients develop conjunctivitis, keratitis, uveitis, retinitis and cranial nerve involvement (oculomotor and optic nerves)
- Later, chronic ocular inflammation, loss of vision, post herpetic neuralgia
All patients should be offered HIV testing.
Investigations
- Visual acuity
- Slit lamp bimicroscopy
- Corneal sensation test
- Fluorescein staining
- HIV Testing
Pharmacological Treatment
B: acyclovir (PO) 800mg 4hourly for 7–10days
AND
A: amitriptyline (PO) 25mg at night for 3months.
Note:
- Treatment should be initiated within 3 days of the onset of symptoms, except in HIV infected patients who should be treated if there are active skin lesions
- Management of Herpes Zoster is multidisciplinary so consult physician for proper management of the patient
Referral
Refer to eye specialist in case of:
- Vesicles on the tip of the nose
- Fluorescein staining of the cornea shows corneal ulceration
- Decreased vision
- Red eye (uveitis or keratitis)
- Cranial nerve palsies