Date of Presentation

5-2-2019 12:00 AM

College

School of Osteopathic Medicine

Poster Abstract

Herpes Zoster Ophthalmicus is a reactivation of a latent Varicella Zoster Virus that specifically involves the eye. The reactivation often occurs during immunocompromised states which allows latent virus in the dorsal root ganglia of sensory nerves to begin viral replication an d s pread via peripheral axons. Diagnosis is based on two characteristic findings; herpetic lesions on the eyelids, forehead, or elsewhere within the V1 dermatome, and ocular findings. Symptoms can vary but are often quite painful. Some patients experience a prodrome of tingling sensation prior to the appearance of a zoster dermatitis . HZO can also present initially as flu like symptoms before developing into pain over a trigeminal nerve dermatome followed by a zoster rash. The rash manifests as an erythematous macular rash that progresses to raised papules, vesicles, and pustules that eventually rupture. Patients with nasocilliary nerve involvement often develop zoster lesions of the distal nose (Hutchinson’s sign). This subset of patients is at much higher risk of developing involvement of the Ocular pain, edema, conjunctival hyperemia, and photophobia are all suggestive of globe involvement. HZO is considered an ophthalmologic emergency. If the infection is left untreated, keratitis, uveitis, retinitis and permanent and severe irreversible vison loss are all potential complications. The diagnosis of HZO is typically made clinically from history and physical exam. Diagnostic testing is not indicated unless there are complications with the course of disease or atypical symptoms leading to clinical uncertainty.

Treatment consists of oral acyclovir or alternate antivirals which have been shown to decrease the adverse outcomes related t o HZO, particularly if started in the first 72 hours of initial onset of symptoms. Additionally, patients with eye involvement should receive topical hydrocortisone ophthalmic ointment to promote skin healing an d provide additional analgesia. Steroid therapy comes with potential risks of immunosuppression and worsening ulceration, however, it should always be used in conjunction with antiviral medications and urgent ophthalmology consultation. Finally, attentive pain control with multimodal analgesia is important to help patients manage painful symptoms.

In high risk patients, IV acyclovir and emergent ophthalmology consultation are recommended. These patients include immunosuppressed patients, those with involvement of the retina or cornea, and those with superimposed bacterial infection.

Keywords

herpes zoster ophthalmicus, HZO, varicella zoster

Disciplines

Eye Diseases | Medicine and Health Sciences | Ophthalmology | Virus Diseases

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May 2nd, 12:00 AM

For Your Eyes Only, Herpes Zoster Ophthalmicus Case Study

Herpes Zoster Ophthalmicus is a reactivation of a latent Varicella Zoster Virus that specifically involves the eye. The reactivation often occurs during immunocompromised states which allows latent virus in the dorsal root ganglia of sensory nerves to begin viral replication an d s pread via peripheral axons. Diagnosis is based on two characteristic findings; herpetic lesions on the eyelids, forehead, or elsewhere within the V1 dermatome, and ocular findings. Symptoms can vary but are often quite painful. Some patients experience a prodrome of tingling sensation prior to the appearance of a zoster dermatitis . HZO can also present initially as flu like symptoms before developing into pain over a trigeminal nerve dermatome followed by a zoster rash. The rash manifests as an erythematous macular rash that progresses to raised papules, vesicles, and pustules that eventually rupture. Patients with nasocilliary nerve involvement often develop zoster lesions of the distal nose (Hutchinson’s sign). This subset of patients is at much higher risk of developing involvement of the Ocular pain, edema, conjunctival hyperemia, and photophobia are all suggestive of globe involvement. HZO is considered an ophthalmologic emergency. If the infection is left untreated, keratitis, uveitis, retinitis and permanent and severe irreversible vison loss are all potential complications. The diagnosis of HZO is typically made clinically from history and physical exam. Diagnostic testing is not indicated unless there are complications with the course of disease or atypical symptoms leading to clinical uncertainty.

Treatment consists of oral acyclovir or alternate antivirals which have been shown to decrease the adverse outcomes related t o HZO, particularly if started in the first 72 hours of initial onset of symptoms. Additionally, patients with eye involvement should receive topical hydrocortisone ophthalmic ointment to promote skin healing an d provide additional analgesia. Steroid therapy comes with potential risks of immunosuppression and worsening ulceration, however, it should always be used in conjunction with antiviral medications and urgent ophthalmology consultation. Finally, attentive pain control with multimodal analgesia is important to help patients manage painful symptoms.

In high risk patients, IV acyclovir and emergent ophthalmology consultation are recommended. These patients include immunosuppressed patients, those with involvement of the retina or cornea, and those with superimposed bacterial infection.

 

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