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Herpes Zoster Ophthalmicus (Treatment (Systemic therapy for Herpes Zoster…
Herpes Zoster Ophthalmicus
Acute infection of Gasserian ganglion of 5th cranial nerve by Varicella Zoster virus
More common in Immunocompromised
Etiology
Children contracted with Chickenpox ➡️ When Depressed Cellular immunity ➡️ Dormant virus in sensory ganglion of 5 the nerve reactivates , replicates & travels down along the branches of 5 the nerve
Clinical features
Frontal nerve more frequently affected
Unilateral lesions
Hutchinson’s rule
➡️ Ocular involvement is frequent when cutaneous involvement of Nasocilliary nerve
Clinical Phases
Acute phase lesions
Fever
Malaise
Neuralgia along the course of 5 the nerve
Cutaneous lesions after 3 to 4 days of onset
Redness & oedema of involved skin
Vesicle formations
Converted into pustules
Bursting of pustules ➡️
Crusting Ulcer
Permanent pitted scar after crust shedding
Ocular lesions
Mucopurulent Conjunctivitis with petechia haemorrhage (Most common)
/ Acute follicular conjunctivitis with regional lymphadenopathy
Zoster keratitis
Fine / Coarse punctate epithelial keratitis
Micro dendritic epithelial Ulcer
Peripheral & Stellate shape
Tapered ends
Nummular Keratitis
Anterior stroma infilterate as Multiple tiny granular deposits surrounded by halo of stroma haze
Disciform keratitis
Episcleritis & Scleritis
Iridocyclitis
Acute retinal necrosis
Secondary Glaucoma
Chronic phase lesions
Post herpetic neuralgia worsens at night
Also called “ANAESTHESIA DOLOROSA”
Lid scarring ➡️ Trichiasis , Entropion,Ptosis
Chronic mucus secreting conjunctivitis
Corneal lesion
Neuroparalytic Ulceration
Exposure keratitis due to facial palsy
Mucuous plaque keratitis develops between 3rd & 5th. Month
Relapsing phase lesions
Due to recurrence even after 10 years of acute phase
Treatment
Systemic therapy for Herpes Zoster
Oral Antiviral
Started immediately after onset of rash
Acyclovir 800 mg 5 times/ day ➡️10 days
Valacyclovir 500 mg TDS
Analgesic
First 2 weeks with severe pain
Combination of Mephenamic acid &Paracetamol / Pentazocin
Systemic steroids
Inhibit development of postherpetic neuralgia
Cimetidine
300 mg QID for 2-3 weeks starting within 48-72 hours of onset
Reduce pain & Pruritis
Amitryptyline
to relieve accompanying depression in acute phase
Local therapy for skin lesions
Antibiotic-Steroid skin ointment/ Lotion
No Zinc calamine application as it promotes crust formation
Local therapy for ocular lesions
For Zoster keratitis, iridocyclitis, Scleritis
Topical steroid eyesdrops
Cycloplegic ointment
Topical acyclovir ointment
For secondary Glaucoma
Timolol / Beatxolol eyedrops
Acetazolamide
For mucous plaques
Topical Acetyl cysteine (Mucolytics)
To prevent secondary infection ➡️ Topical Antibiotics
Surgical Treatment
For Neuroparalytuc Corneal Ulcer
Lateral Tarsorrhaphy
Amniotic membrane transplantation
Bandage contact lens with Tissue Adhesives
Keratoplasty