Ocular involvement in varicella

Causes of infectious pediatric uveitis: A review

Infectious pediatric uveitis is a rare disease that can cause severe ocular damage if not detected rapidly and treated properly. Additionally, early identification of an infection can protect the child from life-threatening systemic infection. Infectious uveitis can be congenital or acquired and may manifest as a primary ocular infection or as a reactivation. Nevertheless, publications on infectious paediatric uveitis are usually limited to a small number of patients or a case report. So far, most studies on uveitis in children have focused primarily on noninfectious uveitis, and a systematic study on infectious uveitis is lacking. In this review, we summarize the literature on infectious uveitis in pediatric populations and report on the epidemiology, pathophysiology, clinical signs, diagnostic tests, and treatment. We will describe the different possible pathogens causing uveitis in childhood by microbiological group (i.e. parasites, viruses, bacteria, and fungi). We aim to contribute to early diagnosis and management of infectious pediatric uveitis, which in turn might improve not only visual outcome, but also the general health outcome.

Conjunctival Lesions Secondary to Systemic Varicella Zoster Virus Infection

Purpose

To report and present images of a case in which discrete conjunctival lesions developed in the setting of primary varicella zoster virus infection (ie, chickenpox).

Methods

Case report and literature review.

Results

This report describes a young, unvaccinated male who developed an acutely painful, red eye in the setting of disseminated primary varicella zoster infection. The cutaneous rash was widespread and included lesions on both eyelids. The patient was found to have multiple discrete de-epithelialized lesions involving the palpebral and bulbar conjunctiva. Throughout the disease course, good visual function was maintained and there was no evidence of intraocular involvement. The ocular surface lesions resolved without sequelae after 1 week of treatment with topical antibiotic ointment.

Conclusions

Primary varicella zoster infection is an increasingly rare phenomenon in the setting of widespread vaccination. However, unvaccinated or undervaccinated individuals and other at-risk populations remain susceptible to developing severe infections. This case of chickenpox involved discrete conjunctival lesions that resolved without sequelae after conservative treatment with topical antibiotic ointment. While serious ophthalmic complications are uncommon in primary varicella infection, clinicians should be aware of the potential for ocular morbidity in this increasingly rare condition.

Stromal Keratitis After Varicella in Children

PURPOSE

We describe here a case series of patients with stromal keratitis of chronic course, a potential manifestation after chickenpox in children.

METHODS

This is a retrospective review of 8 eyes (7 children) with stromal keratitis after varicella seen in our referral cornea center. All patients received a systemic antiviral treatment with oral acyclovir and topical steroid eye drops. Topical cyclosporine eye drops were associated with steroids in case of steroid dependence or steroid-related side effects. Both antiinflammatory treatments were slowly tapered over time.

RESULTS

Median age at diagnosis was 3 years and 4 months. Stromal keratitis was unilateral in 6 children (85.7%) and consisted of superficial nummular keratitis in 4 cases and deep stromal diffuse keratitis in 3 cases. During the median follow-up of 31 months (range, 13-59 months), 6 children had 1 to 6 episodes of relapse. The median duration of topical steroid eye drop was 26 months (range, 2-59 months). Topical cyclosporine eye drops were used with steroids in 3 patients (42.9%). Three patients stopped topical steroids after 2, 5, and 8 months, without recurrence. Four patients were still undergoing treatment after a median of 43 months (range, 26-59 months). All patients regained a best-corrected visual acuity of 20/20 at the end of the follow-up.

CONCLUSIONS

Stromal keratitis after varicella is an entity with a potential chronic course lasting 3 months or more. Steroid dependence and relapses during tapering are 2 major challenges for the management.

A case of internal ophthalmoplegia associated with varicella zoster

The authors report a case of internal ophthalmoplegia in a 5-year-old boy presenting after primary varicella infection. This is an uncommon and mostly irreversible ocular manifestation after chickenpox. The internal ophthalmoplegia showed a potential mild improvement with oral acyclovir. Consideration should be given to starting treatment on presentation in such cases.

The eye in virology

This article outlines the ocular complications of viral infection. The emphasis is on the most common viruses encountered by the physician, and their clinical features and treatment are discussed while demonstrating the variation and often significant sequelae of ocular viral infection.

Red eye in chickenpox: varicella-related acute anterior uveitis in a child

Varicella-zoster virus is a common viral infection of childhood. This report concerns an 8-year-old girl who presented with a 5-day history of a typical varicella rash. She then developed red left eye 'conjunctivitis'. She had no discharge, mild pain and intense photophobia. She was referred to the acute eye clinic after 1 day and she was noted to have acute anterior uveitis. She was treated with gutt atropine 1% for 2 weeks until the inflammation resolved. She had no sequalae.

Ocular Manifestations After Primary Varicella Infection

PURPOSE

To report a case of ocular manifestations after a primary varicella infection.

METHODS

Review of the literature and a case report of a 10-year-old male patient with history of blurry vision and an enlarged pupil 2 months after a varicella infection. Examination revealed uveitis, interstitial keratitis, and internal ophthalmoplegia.

RESULTS

The uveitis resolved with topical steroids; the interstitial keratitis resolved with a faint scar, and the internal ophthalmoplegia persisted.

CONCLUSION

This case report describes a patient with uncommon ocular manifestations after primary varicella.

Panuveitis as presenting sign of chickenpox in a young child

CASE REPORT

A previously healthy 2-year-old girl presented with severe panuveitis in her left eye. She developed chickenpox rash several days later. DNA particles of varicella-zoster virus (VZV) were detected by polymerase chain reaction (PCR) in the aqueous humor. No antiviral regimen was administered. The uveitis resolved completely after 1 week.

COMMENTS

Patients with chickenpox should undergo a thorough ophthalmologic examination at the onset of visual symptoms. Clinicians should be aware of the rare occurrence of chickenpox when evaluating a uveitis patient. If there is suspicion of chickenpox, the clinician may consider ordering serology or PCR tests.

Retinitis following varicella in a vaccinated child with acute lymphoblastic leukemia

Serious ocular disease following varicella (chickenpox) is rare in children. In addition, retinitis in children with hematologic malignancies may present a difficult diagnostic challenge because infectious retinitis may mimic leukemic involvement of the eye. We report a 7-year-old patient with T-cell acute lymphoblastic leukemia in remission who presented with visual complaints 2 weeks after developing chickenpox. Ophthalmologic evaluation revealed acute retinitis in the right eye. Prolonged therapy with acyclovir resulted in near complete recovery. Early diagnosis of VZV retinopathy and aggressive antiviral treatment is critical to prevent acute and long-term ocular sequelae.

Retinal vasculitis associated with chickenpox

PURPOSE

To report retinal vasculitis in a young, immunocompetent Asian female adult with chickenpox.

METHODS

Interventional case report. A 32-year-old woman had chickenpox 2 weeks before blurred vision in the left eye. The visual acuity was 20/20 for the right eye and 30/50 for the left eye. The left eye presented keratic precipitates, moderate (2+) cells in the anterior chamber and numerous cells (3+) in the vitreous. The disk was normal. Perivenous exudation was noted mainly in the inferior retina. The sheathed retinal vessels showed late staining but no remarkable leakage on fluorescein angiography. The right eye was normal.

RESULTS

After treatment with acyclovir for 10 days, the visual acuity in the left eye improved to 20/20, and the vasculitis resolved.

CONCLUSION

Retinal vasculitis may present as a complication of primary varicella infection in an immunocompetent adult.

Varicella disciform stromal keratitis

We treated five patients, aged 26, 4, 6, 13, and 7 years, who developed disciform stromal keratitis one, four, four, eight, and ten weeks, respectively, after the onset of the acute vesicular exanthema. Serologic testing confirmed recent varicella and excluded other infectious causes in two cases. After initial improvement with a topical corticosteroid, three patients developed recurrent corneal inflammation resembling zoster keratitis. These cases and previous reports indicate that varicella-zoster virus is a cause of disciform stromal keratitis that may occur and recur several weeks or months after the primary skin rash has resolved.

Chickenpox chorioretinitis

Chickenpox infection in an adult was complicated by peripheral chorioretinitis and treated with oral acyclovir. Similarities of this case to the recently proposed mild type of acute retinal necrosis syndrome are discussed.

Iritis in children with varicella

A prospective study that included 82 consecutive children seen over 2 years by five pediatricians was undertaken to determine the incidence of iritis in children with chickenpox. Twenty-one (25%) children without pox on their lids were found to have iritis. Follow-up of children with objective evidence of iritis revealed no long-term sequelae.