Categories
Ocular System

Herpes zoster ophthalmicus (HZO)

Varicella zoster virus (VZV) reactivation in ophthalmic division of the trigeminal nerve and subsequently the eye.

Varicella zoster virus (VZV) reactivation in ophthalmic division of the trigeminal nerve and subsequently the eye.

  • OPHTHALMOLOGIC EMERGENCY (as sequelae often include severe chronic pain and vision loss)

Clinical features

  • Burning/shooting pain followed by an erythematous vesicular/pustular rash to the same area
Acute herpes zoster ophthalmicus (HZO) with blisters and eyelid swelling (a). Chronic corneal epithelial defect in an anaesthetic cornea (b). Corneal anaesthesia complicated by secondary corneal calcification (c) and vascularisation (d). | Tuft S. (2020). How to manage herpes zoster ophthalmicus. Community eye health, 33(108), 71–72.

Constitutional symptoms:

Fever, fatigue, malaise, and headaches

Ocular manifestations:

  • Conjunctivitis
  • Uveitis
  • Episcleritis
  • Keratitis
  • Retinitis

Hutchinson sign:

Indicates nasociliary branch involvement of V1

Management

Supportive care:

Artificial tears, cold compresses, and analgesics

Antiviral agents:

Treatment with systemic antiviral agents should begin within 72 hours of disease onset
  • Acyclovir
  • Valacyclovir
  • Famciclovir

Topical antibiotics

Help prevent secondary bacterial infection.
  • Erythromycin ophthalmic ointment)

Corticosteroids:

  • Systemic corticosteroids: Herpes zoster treatment, including HZO.
  • Topical corticosteroids: Stromal keratitis, uveitis, and trabeculitis.

Topical aqueous suppressants:

Used in combination with topical corticosteroids in the treatment of elevated IOP secondary to HZO

Debridement:

In cases of epithelial keratitis.

Leave a Reply