Herpes zoster ophthalmicus
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Etiology
- Herpes zoster
- risk for Herpes zoster ophthalmicus does not seem to correlate with age, gender, or severity of rash[11]
Epidemiology
- 3-6% of U.S. in their lifetime[10]
- 10-20% of shingles involve ophthalmic division of trigeminal nerve
Pathology
- herpes viruses can affect almost every ocular structure, from cornea to retina[9]
Clinical manifestations
- manifestations in distribution of the ophthalmic division of trigeminal nerve
- unilateral dermatomal involvement characteristic of shingles
- paresthesias on affected side[9]
- 75% of patients with zoster have prodromal pain (prodromal to skin eruption)[10]
- vesicular skin eruption (rash)
- up to 2/3 of patients with herpes zoster ophthalmicus have ocular manifestations in addition to the cutaneous lesions
- unilateral red eye[9]
- eye pain
- visual impairment[2]
- photophobia[2]
- cornea, conjunctiva, iris, retina, optic nerve may be involved[10]
- corneal pseudodendrites, a form of keratitis are common
- involvement of nasociliary branch of the ophthalmic nerve (30-40%) which innervates tip of nose & cornea[10]
- unilateral involvement of the nose (Hutchinson sign) increases the likelihood of ocular involvement
* images[4][5][8] Ophthalmoscopy:
Management
- antiviral treatment for Herpes zoster
- refer to ophthalmology within 24 hours
More general terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 15,16.17,18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ 2.0 2.1 2.2 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ 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 Nov;17(11):1183-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21175516
- ↑ 4.0 4.1 Janniger CK, MD; Elston DM (images) Medscape: Herpes Zoster http://emedicine.medscape.com/article/1132465-overview
- ↑ 5.0 5.1 Wikipedia: Herpes zoster ophthalmicus https://en.wikipedia.org/wiki/Herpes_zoster_ophthalmicus
- ↑ Pavan-Langston D. Herpes zoster antivirals and pain management. Ophthalmology. 2008 Feb;115(2 Suppl):S13-20. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18243927
- ↑ Zaal MJ, Volker-Dieben HJ, D'Amaro J. Prognostic value of Hutchinson's sign in acute herpes zoster ophthalmicus. Graefes Arch Clin Exp Ophthalmol. 2003 Mar;241(3):187-91. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12644941
- ↑ 8.0 8.1 Brady MP (images) Cutaneous and Mucosal Manifestations of Viral Diseases. Medscape. March 2017 http://reference.medscape.com/features/slideshow/viral-skin
- ↑ 9.0 9.1 9.2 9.3 Hobbs BN Seeing Red: Five Eye Diagnoses Not to Miss Medscape - Apr 23, 2018. https://www.medscape.com/viewarticle/895295
- ↑ 10.0 10.1 10.2 10.3 10.4 Rothaus C A Man with a Rash on the Scalp and Face. NEJM Resident 360. April 21, 2021 https://resident360.nejm.org/clinical-pearls/a-man-with-a-rash-on-the-scalp-and-face
- ↑ 11.0 11.1 James W. Fast Five Quiz: Herpes Zoster Facts vs Fiction. Medscape - Sep 22, 2021 https://reference.medscape.com/viewarticle/959182
- ↑ Frary J, Peterson PT, Pareek M. Hutchinson's sign of ophthalmic zoster. Clin Case Rep. 2019;8(1):219-220 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31998523 PMCID: PMC6982495 Free PMC article https://onlinelibrary.wiley.com/doi/10.1002/ccr3.2596
- ↑ Ting DSJ, Ghosh N, Ghosh S. Herpes zoster ophthalmicus. BMJ. 2019;364:k5234 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30655269 https://www.bmj.com/content/364/bmj.k5234
- ↑ Vrcek I, Choudhury E, Durairaj V. Herpes zoster ophthalmicus: a review for the internist. Am J Med. 2017;130(1):21-26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27644149 https://www.amjmed.com/article/S0002-9343(16)30930-5/fulltext
- ↑ NEJM Knowledge+ Ophthalmology