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Rissardo JP, Patel P, Fornari Caprara AL. Herpes zoster ophthalmicus presenting with orbital myositis prior to the appearance of vesicular lesions: A case report and mini‑review of the literature. MEDICINE INTERNATIONAL 2024; 4:61. [PMID: 39161884 PMCID: PMC11332323 DOI: 10.3892/mi.2024.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/23/2024] [Indexed: 08/21/2024]
Abstract
All orbital tissues, including extra-ocular muscles, can be affected by the varicella-zoster virus (VZV). However, only a minority of all individuals with herpes zoster infections present with herpes zoster ophthalmicus. The present study reports the case of a middle-aged male patient presenting with an acute intractable right-sided headache. His neurological examination yielded normal results. The analysis of cerebrospinal fluid by biochemistry and cultural analysis yielded normal results; however, the analysis of this fluid using polymerase chain reaction yielded a positive result for VZV. Thus, treatment with acyclovir was commenced. Brain magnetic resonance imaging revealed a bilateral intraorbital intraconal enhancement consistent with myositis. His symptoms evolved into a shock-like pain over the scalp associated with painful ocular movements. On the 2nd day of admission, he developed new vesicular lesions found on the right-side cranial nerve V1 dermatome. By the 6th day of admission, he was asymptomatic, and his physical examination revealed the resolution of the dermatologic manifestations of the VZV. The patient was stable for outpatient follow-up with ophthalmology and was discharged on an oral valacyclovir course for 7 days. To the authors' knowledge, there are four cases reported in the literature of herpes zoster ophthalmicus with orbital myositis prior to the appearance of vesicular lesions. Thus, it is suggested that VZV serology be investigated before a final diagnosis of idiopathic orbital myositis is made.
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Affiliation(s)
| | - Pranav Patel
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
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Tao BK, Soor D, Micieli JA. Reply to: "Comment on Herpes Zoster in neuro-ophthalmology: a practical approach". Eye (Lond) 2024:10.1038/s41433-024-03378-6. [PMID: 39375486 DOI: 10.1038/s41433-024-03378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/09/2024] Open
Affiliation(s)
- Brendan K Tao
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Deep Soor
- Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada
| | - Jonathan A Micieli
- Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Kensington Vision and Research Center, Toronto, ON, Canada.
- St. Michael's Hospital, Toronto, ON, Canada.
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Tao BKL, Soor D, Micieli JA. Herpes zoster in neuro-ophthalmology: a practical approach. Eye (Lond) 2024; 38:2327-2336. [PMID: 38538778 PMCID: PMC11306775 DOI: 10.1038/s41433-024-03030-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/12/2024] [Accepted: 03/08/2024] [Indexed: 08/09/2024] Open
Abstract
Herpes Zoster (HZ) or shingles is the reactivation of the Varicella Zoster Virus (VZV), usually along a single sensory nerve, but can affect both sensory and motor cranial nerves. Major risk factors for HZ include immunosuppressed status and age older than 60 years. In the United States, the lifetime risk of HZ is approximately 30%. Worldwide, the median incidence of HZ is 4-4.5 per 1000 person-years across the Americas, Eurasia, and Australia. HZ ophthalmicus, occurring in 10-20% of patients, is an ophthalmic emergency characterized by VZV reactivation along the V1 branch of the trigeminal nerve. Approximately half of this patient subgroup will go on to develop ocular manifestations, requiring prompt diagnosis and management. While anterior segment complications are more common, neuro-ophthalmic manifestations are rarer and can also occur outside the context of overt HZ ophthalmicus. Neuro-ophthalmic manifestations include optic neuropathy, acute retinal necrosis or progressive outer retinal necrosis, cranial neuropathy (isolated or multiple), orbitopathy, and CNS manifestations. Although typically a clinical diagnosis, diagnosis may be aided by neuroimaging and laboratory (e.g., PCR and serology) studies. Early antiviral therapy is indicated as soon as a presumptive diagnosis of VZV is made and the role of corticosteroids remains debated. Generally, there is wide variation of prognosis with neuro-ophthalmic involvement. Vaccine-mediated prevention is recommended. In this review, we summarize neuro-ophthalmic manifestations of VZV.
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Affiliation(s)
- Brendan Ka-Lok Tao
- Faculty of Medicine, The University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Deep Soor
- Faculty of Arts & Science, University of Toronto, 100 St. George Street, Toronto, ON, M5S 3G3, Canada
| | - Jonathan A Micieli
- Faculty of Arts & Science, University of Toronto, 100 St. George Street, Toronto, ON, M5S 3G3, Canada.
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Toronto, ON, M5T 3A9, Canada.
- Division of Neurology, Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Toronto, ON, M5S 3H2, Canada.
- Kensington Vision and Research Center, 340 College Street, Toronto, ON, M5T 3A9, Canada.
- St. Michael's Hospital, 30 Bond Street, 7 Donnelly Eye Clinic, Toronto, ON, M5B 1W8, Canada.
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Kabaalioglu Guner M, Weldy E, Abou-Jaoude MM. Herpes-Zoster-Related Choroidopathy - A Report of Two Cases. Ocul Immunol Inflamm 2024:1-4. [PMID: 38412396 DOI: 10.1080/09273948.2024.2320709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE To report a rare finding, choroidopathy, in herpes zoster ophthalmicus (HZO). METHODS Report of two cases. RESULTS Multiple, well-defined, choroidal depigmented lesions were demonstrated in two cases of HZO on fundus color imaging, optical coherence tomography, fundus angiography, and indocyanine green angiography at 6 months. CONCLUSION This report demonstrates a very rare, late finding of choroidal involvement in two HZO cases.
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Affiliation(s)
| | - Eric Weldy
- Department of Ophthalmology, University of Kentucky, Lexington, Kentucky, USA
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Martins-Martinho J, Pintado Maury I, Leal I, Ponte C. Varicella zoster virus mimicking giant cell arteritis. ARP RHEUMATOLOGY 2024; 3:73-74. [PMID: 38368558 DOI: 10.63032/rfqw9758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Affiliation(s)
- Joana Martins-Martinho
- Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - Inês Pintado Maury
- Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - Inês Leal
- Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - Cristina Ponte
- Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
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Takai Y, Yamagami A, Iwasa M, Inoue K, Wakakura M. A Case of Herpes Zoster Ophthalmicus With Multiple Delayed Ocular Complications. Cureus 2023; 15:e37134. [PMID: 37153243 PMCID: PMC10159690 DOI: 10.7759/cureus.37134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
Herpes zoster ophthalmicus (HZO) presents a variety of ocular complications, most of which occur simultaneously as skin lesions. We report a case of HZO with delayed onset of multiple ocular complications. A 72-year-old man developed HZO, blepharitis, iritis, and conjunctivitis in the left eye, which resolved after topical ocular treatment and systemic acyclovir administration. However, six weeks after the first onset of the rash, the patient came to our hospital because of recurrent blepharitis, iritis, scleritis, conjunctivitis, eye pain, ptosis, and blurred vision in the left eye. Best corrected visual acuity (BCVA) in the left eye had decreased to hand motion, and the Goldmann visual field test showed only mild residual peripheral vision on the lateral side. Intraocular pressure showed 25 mmHg in the left eye and inflammation in the anterior chamber with paralytic mydriasis. Orbital magnetic resonance imaging (MRI) showed the contrast effects with the lacrimal gland, superior ophthalmic vein, supraorbital nerve, optic nerve, and around optic nerve sheath. The patient was diagnosed with optic neuritis, optic perineuritis, ptosis, paralytic mydriasis, trigeminal neuralgia, lacrimal gland inflammation, blepharitis, iritis, scleritis, and ocular hypertension after HZO, and three courses of steroid pulse therapy were administered. Thereafter, BCVA improved to 0.3 in the left eye, with improvement in central vision, and MRI lesions and other symptoms also improved. The patient has had no complications or recurrence of HZO. HZO can cause a variety of ocular complications. Since autoimmune mechanisms might be involved, combined immunotherapy should be considered.
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Ashikawa Y, Kusunoki Nakamoto F, Sato T, Katsumata J, Bannai T, Seki T, Takeda M, Shiio Y. Successful Treatment of Herpes Zoster Ophthalmicus Complicated by Intense Orbital Inflammation Using Laser Irradiation over the Stellate Ganglion. Intern Med 2023; 62:623-627. [PMID: 35831112 PMCID: PMC10017239 DOI: 10.2169/internalmedicine.9503-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 56-year-old man presented with right-sided headache and ptosis accompanied by a facial skin rash. He was diagnosed with herpes zoster ophthalmicus (HZO). Despite acyclovir and steroid therapy, the ocular symptoms worsened. Magnetic resonance imaging (MRI) revealed severe orbital inflammation and abnormal lesions in the right trigeminal nucleus and tract. The effects of re-administration of intravenous acyclovir and steroid pulse therapy were limited. Laser irradiation of the stellate ganglion (SGL) and high-dose oral prednisolone therapy were effective. Our experience suggests the efficacy of early multimodal treatment, including SGL, in treating ocular symptoms associated with HZO.
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Affiliation(s)
| | | | - Tatsuya Sato
- Department of Neurology, Tokyo Teishin Hospital, Japan
| | | | - Taro Bannai
- Department of Neurology, Tokyo Teishin Hospital, Japan
| | - Tomonari Seki
- Department of Neurology, Tokyo Teishin Hospital, Japan
| | - Masako Takeda
- Department of Anesthesiology, Tokyo Teishin Hospital, Japan
| | - Yasushi Shiio
- Department of Neurology, Tokyo Teishin Hospital, Japan
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Srimanan W, Panyakorn S. Orbital apex syndrome due to herpes zoster infection in a patient with chronic kidney disease: A case report. Clin Case Rep 2023; 11:e6839. [PMID: 36654694 PMCID: PMC9834609 DOI: 10.1002/ccr3.6839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
We report the case of an 89-year-old man with typical herpes zoster ophthalmicus on the left side of his face with delayed clinical presentation of orbital apex syndrome. After treatment with intravenous antiviral agents and corticosteroids, the patient fully recovered. Clinical suspicion should be concerned in immunocompromised cases.
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Meyer JJ, Liu K, McGhee CNJ, Danesh-Meyer HV, Niederer RL. Neurotrophic Keratopathy After Herpes Zoster Ophthalmicus. Cornea 2022; 41:1433-1436. [PMID: 35120347 DOI: 10.1097/ico.0000000000003003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to describe risk factors for neurotrophic keratopathy (NK) after herpes zoster ophthalmicus (HZO). METHODS This study was a retrospective review of all patients seen at the Auckland District Health Board with HZO from 2006 through 2016. Cox proportional hazards analysis was performed to examine time to development of neurotrophic keratitis. RESULTS Eight hundred sixty-nine patients were included in the study with a median follow-up of 6.3 years (5504.4 patient-years). The median age was 65.5 years (interquartile range 52.9-75.4), and 456 subjects (52.5%) were male. NK developed in 58 patients (6.7%), with the highest hazard 1 to 2 years after onset of HZO. On univariate analysis, age, White ethnicity, best-corrected visual acuity (BCVA) at presentation, intraocular pressure, corneal involvement, uveitis, and number of recurrences were associated with increased risk of NK. On multivariate analysis, the following factors were significant: age (hazard ratio [HR] = 1.03; P = 0.021), White ethnicity (HR = 3.18; P = 0.015), BCVA (HR = 1.81; P = 0.026), uveitis (HR = 3.77; P = 0.001), and recurrence (HR = 1.34; P < 0.001). Vision loss (BCVA ≤6/15) was more frequent in subjects with NK (65.5% vs. 16.3%, P < 0.001). CONCLUSIONS NK is a relatively common and serious complication of HZO and occurs more frequently in older White individuals, those with poor visual acuity at presentation, and those with uveitis. Vision loss occurs in approximately two-thirds of patients.
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Affiliation(s)
- Jay J Meyer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Scalabrin S, Becco A, Vitale A, Nuzzi R. Ocular effects caused by viral infections and corresponding vaccines: An overview of varicella zoster virus, measles virus, influenza viruses, hepatitis B virus, and SARS-CoV-2. Front Med (Lausanne) 2022; 9:999251. [PMID: 36388944 PMCID: PMC9643669 DOI: 10.3389/fmed.2022.999251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/30/2022] [Indexed: 09/19/2023] Open
Abstract
Many viral infections can affect vision and the visual system. Vaccination to prevent diseases is commonplace today, acting by stimulating an immune response without developing the pathology. It involves the production of persisting antibodies against the pathogen and the activation of T cells. Certain diseases have already been eradicated by rigorous vaccination campaigns, while others are hoped to be eliminated soon. Vaccines currently available on the market are largely safe, even if they can rarely cause some adverse effects, such as ocular complications. Analyzing existing literature, we aimed to compare the pathological effects on the eye due to the most common viral infections [in particular varicella zoster virus (VZV), measles virus, influenza viruses, hepatitis B virus, and SARS-CoV-2] with the possible ocular adverse effects of their relative vaccines, in order to establish a risk-benefit relationship from an ophthalmological point of view.
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Affiliation(s)
| | | | | | - Raffaele Nuzzi
- Department of Surgical Sciences, Eye Clinic, University of Turin, Turin, Italy
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11
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Lee SH, Chun YS, Kim KW. Coin-shaped corneal endothelial scar in herpes zoster ophthalmicus: a case report. J Med Case Rep 2022; 16:107. [PMID: 35296348 PMCID: PMC8928647 DOI: 10.1186/s13256-022-03319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background Herpes zoster ophthalmicus includes a wide spectrum of lesions at the ocular surface, including epithelial, stromal, endothelial keratitis, and uveitis. Thus far, the occurrence of corneal endothelial disorder in herpes zoster ophthalmicus and the causative virus have not been confirmed, and the differential diagnosis and establishment of therapeutic strategies are challenging. Corneal endothelial coin-shaped lesions are well known to occur in cytomegalovirus-related corneal endotheliitis but have not been reported in patients with herpes zoster ophthalmicus. Case presentation A 39-year-old Asian female was referred to our ophthalmology department with recurrent anterior uveitis accompanied by coin-shaped corneal endothelial scar-like lesions that appeared after right facial herpes zoster. Diffuse corneal stromal haziness was mostly limited in the anterior stroma. The coin-shaped corneal endothelial lesions were separate from stromal lesions and showed a high-reflective scar-like line in sections of anterior segment optical coherence tomography. Anterior uveitis recurred each time she discontinued oral antiviral drug treatment for 12 months after the first event, but was remitted by the maintenance medications of combined topical ganciclovir gel with oral valaciclovir, at a dose lower than the usual adult dose, for acute or recurrent zoster-associated anterior uveitis. Corneal endothelial function remained normal and corneal endothelial and stromal lesions were unchanged throughout the treatment and follow-up period. Conclusions In patients with a history of facial herpes zoster with coin-shaped corneal endothelial scar accompanying recurrent anterior uveitis, suspicion for active varicella-zoster virus is warranted, and prolonged intake of oral antiviral agents is required despite varicella-zoster virus DNA not being detected in aqueous humor.
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Affiliation(s)
- Seung Hyeun Lee
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Yeoun Sook Chun
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Kyoung Woo Kim
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.
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Abstract
The morphology of keratic precipitates (KPs) may yield important diagnostic clues. However, KPs have not been described in a standardized manner and the traditional classification of granulomatous or non-granulomatous KPs is not helpful in differentiating infectious from noninfectious uveitis. A granulomatous uveitis may initially appear non-granulomatous. We suggest three ways to examine KPs that may aid in differentiating the infectious from noninfectious etiologies. The first method is the in vivo confocal microscopy (IVCM) description and classification of KPs, in which the "non-granulomatous" subset of dendritiform and infiltrative KPs should be differentiated from smooth-rounded KPs and globular KPs which are "granulomatous." The second and third clues are the distribution and color of the KPs. KPs that extend beyond the midline may suggest an infective cause, and fresh pigmented KPs suggest a viral cause. Careful examination of the KPs may immediately reveal the clues to the diagnosis, minimizing unnecessary tests and costs.
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Affiliation(s)
- Nicole Shu-Wen Chan
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Graduate Medical School Singapore, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Long CP, Bakhoum MF, Freeman WR. Depigmented Chorioretinal Lesions Following Varicella-Zoster Virus Infection. JAMA Ophthalmol 2020; 138:e201652. [PMID: 33180134 DOI: 10.1001/jamaophthalmol.2020.1652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christopher P Long
- Shiley Eye Institute and Jacobs Retina Center, the Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Mathieu F Bakhoum
- Shiley Eye Institute and Jacobs Retina Center, the Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - William R Freeman
- Shiley Eye Institute and Jacobs Retina Center, the Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
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Abstract
The article reviews the main ocular features of Herpes Zoster Ophthalmicus (HZO) including Ramsay-Hunt and Tolosa-Hunt syndromes that involve III, IV and VI pairs of cranial nerves and I branch of the trigeminal nerve, and describes treatment methods of its active manifestations and postherpetic neuralgia, as well as herpes zoster vaccination practices.
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Affiliation(s)
| | | | - O I Pimonova
- Research Institute of Eye Diseases, Moscow, Russia
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Abstract
BACKGROUND Approximately 1 million new cases of herpes zoster (HZ) occur in the United States annually, including 10%-20% with herpes zoster ophthalmicus (HZO). Postherpetic neuralgia, a debilitating pain syndrome occurs in 30% HZ, whereas 50% HZO develop ophthalmic complications. Diplopia from cranial nerve palsy occurs in less than 30% HZO, whereas optic neuropathy is seen in less than 1% HZO. We reviewed recent developments in the diagnosis, treatment, and prevention of HZ as well as neurological and ophthalmological complications of relevance to the neuro-ophthalmologist. EVIDENCE ACQUISITION We searched the English language literature on Pubmed and Google scholar for articles relevant to the various sections of this review. RESULTS Antiviral treatment should be initiated within 48-72 hours of onset of HZ and HZO to decrease pain and reduce complications. We recommend neuroimaging in all patients with neuro-ophthalmic manifestations such as diplopia and acute vision loss. Diagnostic confirmation using polymerase chain reaction and serology on paired serum and cerebrospinal fluid samples should be obtained in those with neurological signs and symptoms or abnormal imaging. Patients with neurological and/or retinal varicella zoster virus (VZV) infection should be treated promptly with intravenous acyclovir. Patients with isolated optic neuropathy or cranial nerve palsy can be managed with oral antivirals. The prognosis for visual recovery is good for patients with isolated optic neuropathy and excellent for patients with isolated ocular motor cranial nerve palsy. CONCLUSIONS HZ produces a spectrum of potentially blinding and life-threatening complications that adversely affect quality of life and increase health care costs. Individuals at risk for HZ, such as the elderly and immunocompromised, should be encouraged to receive the highly effective VZV vaccine to prevent HZ and its complications.
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Chan NS, Chee S. Demystifying viral anterior uveitis: A review. Clin Exp Ophthalmol 2018; 47:320-333. [DOI: 10.1111/ceo.13417] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/07/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | - Soon‐Phaik Chee
- Singapore National Eye Centre Singapore Singapore
- Singapore Eye Research Institute Singapore Singapore
- Department of Ophthalmology, Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
- Duke‐NUS Medical School Singapore Singapore
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Kocaoğlu G, Utine CA, Yaman A, Men S. Orbital Apex Syndrome Secondary to Herpes Zoster Ophthalmicus. Turk J Ophthalmol 2018; 48:42-46. [PMID: 29576898 PMCID: PMC5854859 DOI: 10.4274/tjo.02256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 07/06/2017] [Indexed: 12/01/2022] Open
Abstract
Orbital apex syndrome is a rare complication of herpes zoster ophthalmicus. A patient being followed in our clinic for herpes zoster ophthalmicus developed orbital apex syndrome in the second week of treatment. Clinical diagnosis was supported by magnetic resonance imaging. Treatment with systemic steroid and antiviral therapy resulted in total regression of ophthalmoplegia at 2 months. However, optic neuropathy-induced vision loss was permanent. This case report examines orbital apex syndrome secondary to herpes zoster ophthalmicus, which has rarely been documented in the ophthalmic literature.
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Affiliation(s)
- Gamze Kocaoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Canan Aslı Utine
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Aylin Yaman
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Süleyman Men
- Dokuz Eylul University Faculty of Medicine, Department of Radiology, İzmir, Turkey
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Ota T, Yamazaki M, Toda Y, Ozawa A, Kimura K. [A case of herpes zoster ophthalmicus preceded one week by diplopia and ophthalmalgia]. Rinsho Shinkeigaku 2017; 57:163-167. [PMID: 28367946 DOI: 10.5692/clinicalneurol.cn-000972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 66-year-old man presented with headache and ophthalmalgia. Diplopia developed, and he was hospitalized. The left eye had abducent paralysis and proptosis. We diagnosed him with Tolosa-Hunt syndrome and administered methylprednisolone at 1 g/day for 3 days. However, the patient did not respond to treatment. No abnormality was found on his MRI or cerebrospinal fluid examination. Tests showed his serum immunoglobulin G4 and antineutrophil cytoplasmic antibody titers were within normal limits. He also had untreated diabetes mellitus (HbA1c 9.2). One week after first presenting with symptoms, herpes zoster appeared on the patient's dorsum nasi, followed by keratitis and a corneal ulcer. Herpes zoster ophthalmicus with ophthalmoplegia was diagnosed. We began treatment with acyclovir (15 mg/kg) and prednisolone (1 mg/kg, decreased gradually). Ophthalmalgia and the eruption improved immediately. The eye movement disorder improved gradually over several months. It is rare that diplopia appears prior to cingulate eruption of herpes zoster ophthalmicus. We speculated that onset of the eruption was inhibited by strong steroid therapy and untreated diabetes mellitus.
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Affiliation(s)
- Tomohiro Ota
- Department of Neurological Science, Chiba Hokusoh Hospital, Nippon Medical School
| | - Mineo Yamazaki
- Department of Neurological Science, Chiba Hokusoh Hospital, Nippon Medical School
| | - Yusuke Toda
- Department of Neurological Science, Chiba Hokusoh Hospital, Nippon Medical School
| | - Akiko Ozawa
- Department of Neurological Science, Chiba Hokusoh Hospital, Nippon Medical School
| | - Kazumi Kimura
- Department of Neurological Science, Nippon Medical School Hospital
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Huang J, Ni Z, Finch P. Gasserian Ganglion and Retrobulbar Nerve Block in the Treatment of Ophthalmic Postherpetic Neuralgia: A Case Report. Pain Pract 2017; 17:961-967. [DOI: 10.1111/papr.12547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/12/2016] [Accepted: 10/19/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Jie Huang
- Department of Physical and Rehabilitation Medicine; Shenyang Medical College; Shenyang China
| | - Zhongge Ni
- Department of Physical and Rehabilitation Medicine; Shenyang Medical College; Shenyang China
- Shenyang Dong-Ao Pain Management Clinic; Shenyang China
| | - Philip Finch
- Perth Pain Management Centre; South Perth Western Australia Australia
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Chandrasekharan A, Gandhi U, Badakere A, Sangwan V. Orbital apex syndrome as a complication of herpes zoster ophthalmicus. BMJ Case Rep 2017; 2017:bcr-2016-217382. [PMID: 28237946 DOI: 10.1136/bcr-2016-217382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Orbital apex syndrome is a rare neuro-ophthalmic manifestation of herpes zoster virus infection. We report one such case with favourable outcome in an immunocompetent patient. A 60-year-old woman presented with rash in the dermatome of the left ophthalmic nerve (V1), followed by sudden loss of vision with complete left-sided external and internal ophthalmoplegia. MRI of brain and orbits with contrast revealed optic perineuritis and myositis without intracranial involvement confirming the diagnosis of orbital apex syndrome. Functional visual recovery was achieved after a course of intravenous and oral steroids under antiviral cover over a follow-up period of 3 months.
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Affiliation(s)
- Anjali Chandrasekharan
- Department of Paediatric and Neuro-ophthalmology, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Uppal Gandhi
- Department of Paediatric and Neuro-ophthalmology, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Akshay Badakere
- Department of Paediatric and Neuro-ophthalmology, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Virender Sangwan
- Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, India
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Mun CY, Jung MS. Clinical Features and Risk Factors of Herpes Zoster Ophthalmicus. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.12.1317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chi Young Mun
- Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Moon Sun Jung
- Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Park JH, Lee JE. An Unusual Case of Orbital Inflammation Preceding Herpes Zoster Ophthalmicus. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.9.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Hyun Park
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
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Chaudhary KP, Mahajan D, Panwar P. Favorable Long-term Prognosis of Cataract Surgery in Herpes Zoster Ophthalmicus. J Ophthalmic Vis Res 2016; 11:221-4. [PMID: 27413505 PMCID: PMC4926572 DOI: 10.4103/2008-322x.183922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: Scleritis is a rare presentation of herpes zoster ophthalmicus, complicated most commonly by iridocyclitis and raised intraocular pressure. These complications can recur in subsequent years, therefore they should be managed well. Case Report: We describe a female patient who developed scleritis, complicated cataract and secondary glaucoma 2 years after being diagnosed by HZO. Secondary glaucoma was managed medically, and the patient underwent extracapsular cataract extraction for the complicated cataract. Final visual acuity was 6/6 and IOP was 22.4 mm Hg. This is a rare report describing favorable long-term (>20 years) prognosis for surgical management of cataract associated with HZO together with scleritis, secondary glaucoma and post-herpetic neuralgia. Conclusion: A favorable outcome may be attained with surgery for complicated cataract associated with HZO if the condition is managed optimally and intraocular inflammation is well controlled.
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Affiliation(s)
| | - Deepti Mahajan
- Department of Ophthalmology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Praveen Panwar
- Department of Ophthalmology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Nodular Scleritis Associated with Herpes Zoster Virus: An Infectious and Immune-Mediated Process. Case Rep Ophthalmol Med 2016; 2016:8519394. [PMID: 27298747 PMCID: PMC4889796 DOI: 10.1155/2016/8519394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/26/2016] [Indexed: 12/30/2022] Open
Abstract
Purpose. To describe a case of anterior nodular scleritis, preceded by an anterior hypertensive uveitis, which was primarily caused by varicella zoster virus (VZV). Case Report. A 54-year-old woman presented with anterior uveitis of the right eye presumably caused by herpetic viral disease and was successfully treated. Two months later, she developed a nodular scleritis and started oral nonsteroidal anti-inflammatory without effect. A complete laboratory workup revealed positivity for HLA-B27; the infectious workup was negative. Therapy was changed to oral prednisolone and an incomplete improvement occurred. Therefore, a diagnostic anterior paracentesis was performed and the polymerase chain reaction (PCR) analysis revealed VZV. She was treated with valacyclovir and the oral prednisolone began to decrease; however, a marked worsening of the scleritis occurred with the reduction of the daily dose; subsequently, methotrexate was introduced allowing the suspension of the prednisolone and led to clinical resolution of the scleritis. Conclusion. This report of anterior nodular scleritis caused by VZV argues in favor of an underlying immune-mediated component, requiring immunosuppressive therapy for clinical resolution. The PCR analysis of the aqueous humor was revealed to be a valuable technique and should be considered in cases of scleritis with poor response to treatment.
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26
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Le TD, Weisbrod D, Mandelcorn ED. Chorioretinitis with exudative retinal detachment secondary to varicella zoster virus. Can J Ophthalmol 2016; 50:e91-3. [PMID: 26455991 DOI: 10.1016/j.jcjo.2015.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 05/20/2015] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Tran D Le
- University of Toronto, Toronto, Ont.
| | - Daniel Weisbrod
- University of Toronto, Toronto, Ont; Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Efrem D Mandelcorn
- University of Toronto, Toronto, Ont; Toronto Western Hospital, University Health Network, Toronto, Ont
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Schaftenaar E, Meenken C, Baarsma GS, McIntyre JA, Verjans GMGM, Peters RPH. Early- and late-stage ocular complications of herpes zoster ophthalmicus in rural South Africa. Trop Med Int Health 2015; 21:334-9. [PMID: 26663773 DOI: 10.1111/tmi.12654] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To describe the spectrum of ocular complications of herpes zoster ophthalmicus (HZO) in rural South Africa. METHODS Patients presenting with visual complaints and active or healed HZO at the ophthalmology outpatient department of three hospitals in rural South Africa were included in this study. Demographic and clinical data were collected, and HIV status was determined for all participants. RESULTS Forty-eight patients were included, and 81% were HIV infected. Poor vision was reported by 94% of patients, painful eye by 79% and photophobia by 63%. A diverse spectrum of ocular complications was observed with corneal inflammation and opacification in 77% followed by anterior uveitis in 65%. The majority (65%) presented with late-stage ocular complications associated with irreversible loss of vision whereas early-stage complications, such as punctate epithelial keratitis and anterior uveitis, were less common. Blindness of the affected eye was observed in 68% of patients with late-stage complications. There was a considerable delay between onset of symptoms and first presentation to the ophthalmology outpatient department (median time 35 days; range 1-2500 days), and longer delay was associated with late-stage ocular complications (P = 0.02). CONCLUSIONS HZO patients present with relatively late-stage ocular complications, and blindness among these patients is common. The delayed presentation to the ophthalmology outpatient department of hospitals in our rural setting is of concern, and efforts to improve ocular outcomes of HZO are urgently needed.
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Affiliation(s)
- Erik Schaftenaar
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.,Rotterdam Eye Hospital, Rotterdam, The Netherlands.,Anova Health Institute, Johannesburg and Tzaneen, South Africa
| | - Christina Meenken
- Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands
| | - G Seerp Baarsma
- Rotterdam Eye Hospital, Rotterdam, The Netherlands.,Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - James A McIntyre
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Georges M G M Verjans
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.,Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, Germany
| | - Remco P H Peters
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
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X G, Xu S, Cheng C, Xú G, Tang WZ, Xu J. Local Administration of Methylcobalamin and Lidocaine for Acute Ophthalmic Herpetic Neuralgia: A Single-Center Randomized Controlled Trial. Pain Pract 2015. [PMID: 26200815 DOI: 10.1111/papr.12328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To determine the therapeutic efficacy of combined methylcobalamin and lidocaine for acute ophthalmic herpetic neuralgia (AOHN). METHODS Based on the onset, patients with AOHN (n = 98) were randomly allocated into groups A (≤ 3 days) and B (4 to 7 days) and then subdivided into control (A0, B0; received intramuscular methylcobalamin in addition to local lidocaine injection) and treatment (A1, B1; received local injection of the methylcobalamin and lidocaine combination for 14 days) groups. Treatment efficacy was assessed based on rash healing time, alteration of pain intensity, and interference with quality of life. Multilevel modeling and survival analysis were performed. RESULTS The time (hours) to start and full opening of the affected eye and the time (hours) to start and full crusting were significantly reduced in both treatment groups (P < 0.05 vs. controls). The mean pain scores in A1 (2.6 ± 0.7) and B1 (1.2 ± 0.8) decreased significantly compared with those in A0 (7.0 ± 1.7) and B0 (5.6 ± 1.9), and the difference between the two therapeutic strategies significantly increased over time. The median minimum intervention time was 6 days in B1 and 11 days in A1. The incidence of postherpetic neuralgia (PHN) was 2.04% at 3 months. CONCLUSIONS Methylcobalamin combined with lidocaine mediated detumescence and improved cutaneous healing of the affected area, as well as a significant and sustained analgesic effect on AOHN. The incidence of PHN was also significantly decreased. Local methylcobalamin intervention within 4 to 7 days of onset may be an effective therapeutic option for AOHN.
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Affiliation(s)
- Gang X
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai, China
| | - Site Xu
- Mechatronic Engineering and Automation School, Shanghai University, Shanghai, China
| | - Chao Cheng
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai, China
| | - Gang Xú
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai, China
| | - Wei-Zhen Tang
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai, China
| | - Jie Xu
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai, China
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30
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Potts A, Williams GJ, Olson JA, Pollock KGJ, Murdoch H, Cameron JC. Herpes zoster ophthalmicus reduction: implementation of shingles vaccination in the UK. Eye (Lond) 2014; 28:247-8. [PMID: 24622628 DOI: 10.1038/eye.2013.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- A Potts
- Vaccine Preventable Diseases, Health Protection Scotland, NHS National Services Scotland, Meridian Court, Glasgow, UK
| | - G J Williams
- Tennant Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - J A Olson
- The Eye Clinic, Aberdeen Royal Infirmary, Aberdeen, UK
| | - K G J Pollock
- Vaccine Preventable Diseases, Health Protection Scotland, NHS National Services Scotland, Meridian Court, Glasgow, UK
| | - H Murdoch
- Vaccine Preventable Diseases, Health Protection Scotland, NHS National Services Scotland, Meridian Court, Glasgow, UK
| | - J C Cameron
- Vaccine Preventable Diseases, Health Protection Scotland, NHS National Services Scotland, Meridian Court, Glasgow, UK
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Wakil SM, Ajlan R, Arthurs B. Herpes zoster ophthalmicus complicated by ipsilateral isolated Bell's palsy: a case report and review of the literature. Can J Ophthalmol 2012; 47:339-43. [DOI: 10.1016/j.jcjo.2012.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 04/11/2012] [Indexed: 10/26/2022]
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Orbital apex syndrome in herpes zoster ophthalmicus. Case Rep Ophthalmol Med 2012; 2012:854503. [PMID: 22830066 PMCID: PMC3399353 DOI: 10.1155/2012/854503] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 03/22/2012] [Indexed: 11/17/2022] Open
Abstract
Orbital apex syndrome is a rare manifestation of Herpes Zoster Ophthalmicus. Herein we report on a case of orbital apex syndrome secondary to Herpes Zoster Ophthalmicus. A 75 year-old male complained of vision loss, conjunctival hyperemia and proptosis on the left eye, was referred to our clinic. Visual acuity was 5/10 Snellen lines and he had conjunctival hyperemia, chemosis, minimal nuclear cataract and proptosis on the left eye. A diagnosis of orbital pseudotumor was demonstrated firstly. The patient received oral and topical corticosteroids, antiinflammatory and antibiotic agents. On day 2, vesiculopustular lesions were observed, Herpes Zoster Ophthalmicus was diagnosed and corticosteroid treatment stopped, oral acyclovir treatment initiated. Two days later, total ophthalmoplegia, ptosis and significant visual loss were observed on the left. The diagnosis of orbital apex syndrome was considered and the patient commenced on an intravenous acyclovir treatment. After the improvement of acute symptoms, a tapering dose of oral cortisone treatment initiated to accelarate the recovery of ophthalmoplegia. At 5-month follow-up, ptosis and ocular motility showed improvement. VA did not significantly improve because of cataract and choroidal detachment on the left. We conclude that ophthalmoplegia secondary to Herpes Zoster Ophthalmicus responds favourably to intravenous acyclovir and steroids.
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Affiliation(s)
- Hyung Tae Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
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Kurimoto T, Tonari M, Ishizaki N, Monta M, Hirata S, Oku H, Sugasawa J, Ikeda T. Orbital apex syndrome associated with herpes zoster ophthalmicus. Clin Ophthalmol 2011; 5:1603-8. [PMID: 22140305 PMCID: PMC3225456 DOI: 10.2147/opth.s25900] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report our findings for a patient with orbital apex syndrome associated with herpes zoster ophthalmicus. Our patient was initially admitted to a neighborhood hospital because of nausea and loss of appetite of 10 days' duration. The day after hospitalization, she developed skin vesicles along the first division of the trigeminal nerve, with severe lid swelling and conjunctival injection. On suspicion of meningoencephalitis caused by varicella zoster virus, antiviral therapy with vidarabine and betamethasone was started. Seventeen days later, complete ptosis and ophthalmoplegia developed in the right eye. The light reflex in the right eye was absent and anisocoria was present, with the right pupil larger than the left. Fat-suppressed enhanced T1-weighted magnetic resonance images showed high intensity areas in the muscle cone, cavernous sinus, and orbital optic nerve sheath. Our patient was diagnosed with orbital apex syndrome, and because of skin vesicles in the first division of the trigeminal nerve, the orbital apex syndrome was considered to be caused by herpes zoster ophthalmicus. After the patient was transferred to our hospital, prednisolone 60 mg and vidarabine antiviral therapy was started, and fever and headaches disappeared five days later. The ophthalmoplegia and optic neuritis, but not the anisocoria, gradually resolved during tapering of oral therapy. From the clinical findings and course, the cause of the orbital apex syndrome was most likely invasion of the orbital apex and cavernous sinus by the herpes virus through the trigeminal nerve ganglia.
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Affiliation(s)
- Takuji Kurimoto
- Department of Ophthalmology, Osaka Medical College, Osaka, Japan
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35
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de Mello Vitor B, Foureaux ECM, Porto FBO. Herpes zoster optic neuritis. Int Ophthalmol 2011; 31:233-6. [DOI: 10.1007/s10792-011-9443-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 05/11/2011] [Indexed: 11/29/2022]
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Adam RS, Vale N, Bona MD, Hasanee K, Farrokhyar F. Triaging herpes zoster ophthalmicus patients in the emergency department: do all patients require referral? Acad Emerg Med 2010; 17:1183-8. [PMID: 21175516 DOI: 10.1111/j.1553-2712.2010.00875.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was to assess the predictive value of clinical signs and symptoms of herpes zoster ophthalmicus (HZO) for development of moderate to severe eye disease. METHODS This was a prospective cohort multicenter study of 54 patients referred to the ophthalmology service after presenting to the emergency department (ED) or primary care clinic with a zosteriform rash of less than 10 days' duration. Upon referral to ophthalmology, easily assessable clinical signs and symptoms were documented. A complete ocular exam was then performed. Patients were followed for 2 months. RESULTS Twenty-three patients (43%) developed moderate to severe disease as defined by corneal or intraocular involvement. Eye redness and rash in the supratrochlear nerve distribution had a statistically significant association with clinically relevant eye disease. All 23 patients who developed moderate to severe eye disease presented with a red eye. Hutchinson's sign (nasociliary nerve involvement) was not predictive of clinically relevant eye disease. CONCLUSIONS Eye redness was 100% sensitive for predicting moderate to severe eye disease in this sample of patients and should necessitate immediate referral for ophthalmologic assessment. Patients lacking eye redness, even with a positive Hutchinson's sign, may not require immediate specialist consultation. All patients not being referred require careful instructions to seek further care should they develop any concerning eye symptoms such as redness, pain, photophobia, or visual disturbance.
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Affiliation(s)
- Robert S Adam
- Department of Ophthalmology, McMaster University, Hamilton, Ontario, Canada.
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38
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Hong SM, Yang YS. A case of optic neuritis complicating herpes zoster ophthalmicus in a child. KOREAN JOURNAL OF OPHTHALMOLOGY 2010; 24:126-30. [PMID: 20379464 PMCID: PMC2851001 DOI: 10.3341/kjo.2010.24.2.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 03/10/2010] [Indexed: 11/23/2022] Open
Abstract
Here we report a case of optic neuritis in the setting of herpes zoster ophthalmicus (HZO) in a child. A six-year-old girl presented with HZO in the right eye. During the hospitalization, her visual acuity decreased. Fluorescein angiography (FAG) and optical coherence tomography revealed optic neuritis in the affected eye. Visual acuity improved with one month of treatment with acyclovir and steroids. FAG analysis showed no evidence of leakage at the optic disc. At one year post treatment, the patient's fundus exam and vision were normal. Therapy with antivirals and steroids may be effective in patients with childhood HZO optic neuritis.
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Affiliation(s)
- Seong Min Hong
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
| | - Yun Sik Yang
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
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39
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Rixen J, Lee AG, Kardon RH. Herpes Zoster Ophthalmicus Related Orbital Inflammatory Syndrome. Semin Ophthalmol 2009. [DOI: 10.1080/08820530903124292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Nakazawa T, Abe T, Ohmura M. Varicella zoster-associated optic neuropathy with choroidal involvement. Neuroophthalmology 2009. [DOI: 10.1076/noph.21.1.39.3923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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41
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Dhingra S, Williams G, Pearson A. Severe, permanent orbital disease in herpes zoster ophthalmicus. Orbit 2008; 27:325-7. [PMID: 18716975 DOI: 10.1080/01676830802222852] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 63-year-old man with HZO presented with involvement of cranial nerves II, III, IV, V, and VI, with proptosis, raised intraocular pressure, and chemosis. With the aid of orbital imaging, a diagnosis of orbital apex inflammation secondary to HZO was confirmed, and he was treated with intravenous acyclovir and oral steroids. Despite this, he made a minimal recovery at eight months following presentation. Severe, irreversible orbital disease may develop following HZO, and an ischemic vasculitis may play a role in the pathogenesis of the disease.
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Affiliation(s)
- Sumit Dhingra
- Eye Department, John Radcliffe Hospital, Oxford, United Kingdom.
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42
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Quisling SV, Shah VA, Lee HK, Policeni B, Smoker WRK, Martin C, Lee AG. Magnetic resonance imaging of third cranial nerve palsy and trigeminal sensory loss caused by herpes zoster. J Neuroophthalmol 2006; 26:47-8. [PMID: 16518167 DOI: 10.1097/01.wno.0000204660.41183.1b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 44-year-old man with right-sided herpes zoster ophthalmicus (HZO) developed ipsilateral third and sixth cranial nerve palsies and first-division trigeminal (fifth cranial nerve) sensory loss. MRI revealed contrast enhancement of the cisternal and cavernous portions of the third cranial nerve and high signal on a FLAIR sequence within the ipsilateral medulla at the presumed location of the trigeminal nucleus and tract. To our knowledge, this is the first report of the combination of these imaging findings in HZO.
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Affiliation(s)
- Susannah V Quisling
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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43
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Abstract
Scleritis is typically a severe painful inflammatory process centered in the sclera that may involve the cornea, adjacent episclera, and underlying uvea; it poses a significant threat to vision. Careful clinical history taking, detailed ocular examination, appropriate investigation for ocular disease with or without underlying systemic disease, and timely intervention with the use of immunosuppressant drugs when necessary, has improved the long-term outcome for patients with this disease.
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Affiliation(s)
- Narciss Okhravi
- Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 2PD, United Kingdom
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Krasnianski M, Sievert M, Bau V, Zierz S. External ophthalmoplegia due to ocular myositis in a patient with ophthalmic herpes zoster. Neuromuscul Disord 2004; 14:438-41. [PMID: 15210167 DOI: 10.1016/j.nmd.2004.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2003] [Revised: 01/14/2004] [Accepted: 03/04/2004] [Indexed: 10/26/2022]
Abstract
External ocular muscle palsies in patients with ophthalmic zoster are traditionally interpreted as diseases of III, IV or VI cranial nerves. Orbital myositis associated with zoster ophthalmicus has been diagnosed only rarely. We describe a patient with ophthalmic zoster and external ophthalmoplegia due to ocular myositis demonstrated by MR imaging. Treatment with acyclovir and cortisone resulted in a rapid improvement of the ophthalmoplegia. In ophthalmic herpes zoster associated with external ocular muscle palsies, ocular myositis is an important differential diagnosis to inflammatory involvement of the cranial nerves III, IV, and VI.
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Affiliation(s)
- M Krasnianski
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
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45
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Alexandri NM, Tavernarakis A, Potagas C, Molari H, Koutra H. Accident vasculaire ischémique cérébral et méningo-encéphalite à herpès simplex 1. Rev Neurol (Paris) 2004; 160:579-81. [PMID: 15269679 DOI: 10.1016/s0035-3787(04)70991-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The etiology of stroke in young patients is often unknown. Although systemic infections as well as specific infection agents, like herpes zoster virus or cysticercus, are often considered as risk factors, there are no indications that herpes simplex type 1 plays a role in the pathogenesis of stroke. We present the case of a young patient who suffered a stroke during a meningoencephalitis due to herpes simplex 1 and we review the relevant literature for a possible relation between the two entities.
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Affiliation(s)
- N-M Alexandri
- Service de Neurologie, Hôpital Général Evangelismos, Athènes, Grèce
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46
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Zaal MJW, Völker-Dieben HJ, D'Amaro J. Visual prognosis in immunocompetent patients with herpes zoster ophthalmicus. ACTA OPHTHALMOLOGICA SCANDINAVICA 2003; 81:216-20. [PMID: 12780396 DOI: 10.1034/j.1600-0420.2003.00057.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the normal spectrum of ocular complications and associated visual outcome in patients with herpes zoster ophthalmicus. METHODS This prospective observational cohort study included 73 immunocompetent adults with herpes zoster ophthalmicus, referred by their general practitioners within 7 days of skin rash onset. The follow-up period was 6 months. All patients received a 7-14-day course of systemic aciclovir treatment combined with longterm application of a lubricating ophthalmic ointment as long as the corneal epithelium was affected. Topical corticosteroids were strictly avoided in the acute phase of ocular disease. Acquired visual loss scores at 1, 2 and 6 months were based on best corrected visual acuity (BCVA) level and evaluation of the ophthalmological history and findings. RESULTS Ophthalmic herpes zoster led to a variety of transient inflammatory reactions within the anterior eye segment of the involved side in 46 patients (63%), but did not seriously compromise their ultimate visual outcome. Mild to moderate visual loss, with corrected VA between 0.3 and 0.8, was found in 17 patients at 1 month (23%), in 10 patients at 2 months (14%) and in seven patients at 6 months follow-up (10%). None of the patients developed visual loss with a corrected VA of less than 0.3. CONCLUSION Functional vision was retained in all ophthalmic zoster patients referred to the ophthalmologist in the acute phase of the disease by vigorous antiviral treatment and adequate prevention of corneal exposure.
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Affiliation(s)
- M J W Zaal
- Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands.
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Berry-Brincat A, Von Lany H, Evans N. Scleromalacia as a complication of herpes zoster ophthalmicus. Eye (Lond) 2003; 17:449-51. [PMID: 12724725 DOI: 10.1038/sj.eye.6700336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Zaal MJW, Völker-Dieben HJ, D'Amaro J. Prognostic value of Hutchinson's sign in acute herpes zoster ophthalmicus. Graefes Arch Clin Exp Ophthalmol 2003; 241:187-91. [PMID: 12644941 DOI: 10.1007/s00417-002-0609-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2002] [Revised: 11/13/2002] [Accepted: 11/14/2002] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the prognostic value of nasociliary skin lesions (Hutchinson's sign) for ocular inflammation and corneal sensory denervation in acute herpes zoster ophthalmicus. METHODS A longitudinal observational study with a 2-month follow-up was performed involving 83 non-immunocompromised adults with acute herpes zoster ophthalmicus, with a skin rash duration of less than 7 days, referred by their general practitioner. All skin lesions at the tip, the side and the root of the nose, representing the dermatomes of the external nasal and infratrochlear branches of the nasociliary nerve, were documented by taking photographs and marking anatomical drawings. Ocular inflammatory signs were observed by slit-lamp biomicroscopy, and corneal sensitivity was measured with the Cochet-Bonnet esthesiometer at 2-month follow-up. RESULTS Hutchinson's sign was a powerful predictor of ocular inflammation and corneal denervation in herpes zoster ophthalmicus [relative risks: 3.35 (CI 95%: 1.82-6.15) and 4.02 (CI 95%:1.55-10.42), respectively]. The manifestation of herpes zoster skin lesions at the dermatomes of both nasociliary branches was invariably associated with the development of ocular inflammation. CONCLUSION Clinicians should be alert for early skin lesions within the complete nasociliary dermatome, because they are a reliable prognostic sign of sight-threatening ocular complications in acute herpes zoster ophthalmicus.
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Affiliation(s)
- Michel J W Zaal
- Department of Ophthalmology, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Miserocchi E, Waheed NK, Dios E, Christen W, Merayo J, Roque M, Foster CS. Visual outcome in herpes simplex virus and varicella zoster virus uveitis: a clinical evaluation and comparison. Ophthalmology 2002; 109:1532-7. [PMID: 12153807 DOI: 10.1016/s0161-6420(02)01113-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare clinical characteristics and outcomes in patients with uveitis caused by herpes simplex virus (HSV) and varicella zoster virus (VZV). DESIGN Retrospective comparative study. PARTICIPANTS Forty patients with HSV uveitis and 24 patients with VZV uveitis. METHODS A retrospective study of 40 patients with HSV and 24 patients with VZV uveitis was performed. The patients were followed between May 1987 and September 1999 (median follow-up time, 46 months). The diagnosis of HSV uveitis was made clinically and serologically, and the diagnosis of VZV uveitis was made clinically. MAIN OUTCOME MEASURES Clinical presentation of the disease, ocular complications, visual acuity, surgical and medical treatments needed. RESULTS Both populations were comparable for gender and age at disease onset. The course of the disease tended to be remitting and recurrent in HSV patients and chronic in VZV patients (P = 0.046). The most frequent ocular complication in both groups was secondary glaucoma (54% HSV, 38% VZV). Twenty-five percent of VZV patients developed posterior pole complications (cystoid macular edema, epiretinal membrane, papillitis, retinal fibrosis, and detachment) compared with 8% of HSV patients (P = 0.069). Treatment modalities selected were generally similar in the two groups, although periocular and systemic steroids were required more frequently in HSV patients (60% versus 25%; P = 0.01). Surgical procedures were required with similar frequency in both populations. The percentage of eyes that were legally blind at end of follow-up was also comparable (HSV, 20%; VZV, 21%). The visual outcome was similar in the studied populations. CONCLUSIONS This study represents the only direct comparison of HSV and VZV uveitis patients reported in the literature. HSV patients were more likely to be treated with periocular and systemic steroids, and VZV patients were more likely to develop posterior pole complications (a finding of borderline significance). Other parameters evaluated in this study were not statistically different in the two patient groups.
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Affiliation(s)
- Elisabetta Miserocchi
- Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114, USA
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Markomichelakis NN, Canakis C, Zafirakis P, Marakis T, Mallias I, Theodossiadis G. Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy. Ophthalmology 2002; 109:879-82. [PMID: 11986091 DOI: 10.1016/s0161-6420(02)00961-2] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To report two cases of recurrent anterior uveitis with sectoral iris atrophy and ocular hypertension during attacks caused by cytomegalovirus (CMV). DESIGN Two observational case reports. PARTICIPANTS Two immunocompetent patients with a history of recurrent unilateral hypertensive anterior uveitis with sectoral iris atrophy were referred to us with the presumptive diagnosis of herpetic uveitis. MAIN OUTCOME MEASURES Comprehensive ophthalmic examination, aqueous humor polymerase chain reaction (PCR), and peripheral blood serologic studies were performed on both patients. RESULTS Examination of aqueous humor by PCR was positive for CMV and negative for herpesvirus. Serum IgG/IgM titers disclosed past CMV infection. Both patients responded well to antiviral therapy with ganciclovir. The final visual acuity level was 20/20 in both eyes of both patients. CONCLUSIONS CMV infection can produce recurrent attacks of anterior uveitis with clinical characteristics indistinguishable from those previously considered highly suggestive or even pathognomonic for herpetic infection. This observation has implications for the therapeutic management of such patients.
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Affiliation(s)
- Nikos N Markomichelakis
- Ocular Inflammation and Immunology Service, Department of Ophthalmology, General Hospital of Athens, Athens, Greece
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