HZO Keratitis
And we talk to our patients all the time about systemic eye diseases. Diabetes, hypertension, cholesterol. Why not also talk to them about getting their zoster vaccination? I think it’s something that we can do - Doug Rett OD
image by: Dr-Ehab Nafie
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Approach to the Red Eye
Similar to HSV keratitis... does not necessarily involve the cornea, but the cornea is involved in ~50% of cases...
Fluorescein will show poorly staining pseudodendrites without a terminal bulb.
*Pearl* Hutchinson sign is when there is a vesicle is on the tip of the nose. This correlates very strongly with a corneal lesion as the nasociliary branch of V1 innervates both the tip of the nose and the cornea.
Treatment: If immunocompetent and only one dermatome: Acyclovir 800 mg PO 5x daily or famciclovir 500 mg PO TID or valacyclovir 1 g PO TID – all for 7-10 days. If immunocompromised or severe life-threatening infection or multiple dermatomes: acyclovir 10mg/kg…
Resources
A Pox On Your Eye
Remember that ocular involvement may occur in the absence of a rash, or days to weeks after the onset of the rash. Patients without ocular involvement should be advised to seek medical attention if they develop new ocular symptoms or signs.
Approach to Corneal Disorders in the ED
What is your differential diagnosis for corneal disorders in the ED? What physical exam and slit lamp findings would you look for?
Clinical Image 21: A Sparkle in the Eye
Upon eruption of vesicular lesions within the trigeminal dermatome, patients will likely experience hyperemic conjunctivitis, blurred vision, and/or lid droop. The rash typically does not cross the midline.
Herpetic Keratitis: A Review and What’s New
And the sobering stat, I think, that one in three of us humans will get shingles sometime in our lifetime. And we as eyecare providers see a lot of complications from the zoster virus in the eye. And we talk to our patients all the time about systemic eye diseases. Diabetes, hypertension, cholesterol. Why not also talk to them about getting their zoster vaccination? I think it’s something that we can do. A small part to help these patients.
Approach to the Red Eye
Similar to HSV keratitis, but instead is caused by varicella zoster virus that is reactivated in the V1 nerve distribution. Does not necessarily involve the cornea, but the cornea is involved in ~50% of cases. Typically affects the older population as immunity wanes. Immunosuppression is a major risk factor that can induce a reactivation as well. Systemic symptoms can also be seen such as fever, fatigue, malaise; however, fewer than 20% of patients will have these symptoms
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