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Skin:
This is a viral infection caused by the cytomegalovirus commonly affecting children. The typical lesion is a pale, waxy elevated nodule on the eyelids.
Clinical Features
Complications
The shedding of cell-laden with viral particles can produce chronic follicular conjunctivitis and superficial keratitis.
Treatment
Expression of the contents of the nodule
Heat cauterisation of the lesions.
Description
This is an infection caused by the varicella-zoster affecting the ophthalmic division of the trigeminal vein.
It is more common and more severe in patients with lymphomas and those being treated by radiotherapy or immunosuppressed individual
Signs and Symptoms
• Severe pain along the ophthalmic division of the trigeminal nerve VI)
• Maculopapular rash along the VI
that obeys mid facial line.
• Swelling of the affected part of the face
• Typical Herpes Zoster rash
Investigations
Clinical – the typical distribution of the Herpes Zoster rash
Treatment
• Oral acyclovir 800mg 5 times daily
• Oxytetracycline 3% + Hydrocortisone 1% eye drops OR
• Betamethasone 0.1% + Neomycin 0.5% eye drops OR
• Dexamethasone 0.1% + Chloramphenicol 1% eye drops 4-6 times daily
• Calamine lotion to the skin or Acyclovir 3% skin ointment
• ± systemic steroids (x-ray to rule out PTB) may activate TB in AIDS patients
• Acyclovir 3% eye ointment 5 times daily
Complications
• Anterior uveitis
• Neurological: cranial nerve palsies, Optic neuritis, Encephalitis, Contra-lateral hemiplegia
• Severe facial skin scarring, Corneal opacification, Neuropathic keratopathy, Disciform keratopathy
Description
This is a rare chronic diffuse exudative infection of the retina caused by the CMV virus which occurs with rare exception, in patients with an impaired immune system caused by either AIDS, cytotoxic chemotherapy or long term immune suppression following organ transplantation.
Signs and Symptoms
• Poor vision
• Floaters
• Cotton wool spots
• Full-thickness retinal necrosis and oedema which starts peripherally or at the posterior pole
• Retinal bleeding, Retinal vasculitis
• The whole retina eventually involved
• Total retinal atrophy, Retinal detachment
Treatment
• Dihydroxypropoxymethyl guanine IV causes regression
• Ganciclovir IV infusion (induction) 5mg/kg 2 times a day for 12-21 days
• Maintenance dose 5 mg/kg wt daily until adequate recovery of immunity
• Foscarnet IV infusion, induction 60mg/kg every 8 hours for 2-3 weeks, then maintenance dose 60mg/kg
daily increased to 90-120mg/kg if tolerated. If CMW progresses while on the maintenance dose repeat the
induction dose. Treatment is needed for life
