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Herpes Zoster

What is herpes zoster ophthalmicus?

Herpes Zoster Ophthalmicus (HZO) is a viral disease characterized by a painful unilateral skin rash in and around the eye. It is frequently associated with  fever, malaise, headache, and pain in the area of the rash. The vesicles typically crust and heal within 2 to 6 weeks. HZO occurs typically in older adults but can present at any age and occur after reactivation of latent varicella-zoster virus (VZV, the chicken pox virus) present in the cerebral ganglia in the brain. Severity of the VZV and the immune status of the host are primary factors leading to the development of HZO.

What are the symptoms of herpes zoster ophthalmicus?

Common conditions seen in patients with HZO include cornea epithelial defects, decreased corneal sensation, and ocular inflammation (iritis). HZO iritis is frequently associated with high intraocular pressure.

What is the treatment for herpes zoster ophthalmicus?

This condition is usually treated with oral antiviral medications for 7 to10 days. Skin vesicles can be treated with antibioic ointments to prevent bacterial superinfection, while  the corneal disease is usually treated with artificial tears and nighttime lubricants (ointments). Topical steroids (such as prednisolone acetate 1%) are only used if the eye shows signs of interstitial keratitis and uveitis.  For episodes of herpes zoster related scleritis, retinitis, choroiditis and optic neuritis, systemic steroids by mouth or intravenous administration should be considered.  Increased intraocular pressure commonly found in herpes trabeculitis (inflammation of the trabecular meshwork, which drains fluid from inside the eye), also responds to topical steroids in conjunction with aqueous suppressants (including timolol, brimonidine, dorzolamide and acetazolamide). Pain should be treated with narcotics, if warranted. Capsaicin cream applied to the rash may decrease pain, as well.

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