acyclovir and Blepharoptosis

We herein report a 90-year-old immunocompromised woman who developed right upper limb weakness and right ptosis with a miotic pupil 1 week after oral therapy for zoster on the right T2 dermatome. The right pupil was dilated with instillation of 1% apraclonidine, indicating Horner's syndrome. The patient was treated with intravenous acyclovir and methylprednisolone. Focal weakness related to zoster, generally known as segmental zoster paresis, improved over five months, but Horner's syndrome remained. We suggest that aggressive intravenous treatment should be considered for rare cases of zoster that occur with a combination of these two neurological conditions.

Topics: Acyclovir; Aged, 80 and over; Blepharoptosis; Female; Herpes Zoster; Horner Syndrome; Humans; Paresis

To present a case of Herpes Zoster Ophtalmicus (HZO), which was reactivated postoperatively after a sinus lift operation.. A 39-year-old male was referred to our clinic for implant-supported dental rehabilitation. He had maxillary missing teeth in positions 13, 14, 15 and 16 and a pneumatised right maxillary sinus with a bone height of 2 mm. Lateral sinus lifting and bone block grafting was performed before implant insertion. Twelve days after the sinus lift, the patient complained of pain and itching at the infraorbital area extending to the forehead. Clinical examination revealed no signs of infection or allergy. The patient received consultation from a dermatologist in order to rule out a possible dermatological disorder. Finally he was diagnosed with HZO.. HZO was managed with systemic acyclovir treatment. Vesicular rashes and ptosis was seen 3 days after the medical treatment. After 1 month no postoperative skin or orbital sequela was seen. Three implants were inserted at the right posterior maxilla 5 months after sinus lift. One-year followup was uneventful.. Dermatological diseases should always be kept in mind during the differential diagnosis of orofacial pain. In this case the proximity of the operation site and affected area gave rise to the idea that surgical trauma had a possible role in the reactivation of the virus. However, the process of reactivation is not entirely understood and requires further investigations. Early diagnosis is essential for HZO in order to avoid debilitating complications such as postherpetic neuralgia and blindness.

Topics: Acyclovir; Adult; Antiviral Agents; Autografts; Blepharoptosis; Bone Transplantation; Dental Implantation, Endosseous; Exanthema; Follow-Up Studies; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Pain, Postoperative; Pruritus; Sinus Floor Augmentation; Virus Activation

A 63-year-old man with HZO presented with involvement of cranial nerves II, III, IV, V, and VI, with proptosis, raised intraocular pressure, and chemosis. With the aid of orbital imaging, a diagnosis of orbital apex inflammation secondary to HZO was confirmed, and he was treated with intravenous acyclovir and oral steroids. Despite this, he made a minimal recovery at eight months following presentation. Severe, irreversible orbital disease may develop following HZO, and an ischemic vasculitis may play a role in the pathogenesis of the disease.

Topics: Acyclovir; Antiviral Agents; Blepharoptosis; Conjunctival Diseases; Drug Therapy, Combination; Edema; Exophthalmos; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Infusions, Intravenous; Intraocular Pressure; Magnetic Resonance Imaging; Male; Middle Aged; Ocular Hypertension; Orbital Diseases; Prednisolone; Tomography, X-Ray Computed

Topics: Acyclovir; Antiviral Agents; Blepharoptosis; Cervical Plexus; Diplopia; Functional Laterality; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Oculomotor Nerve; Oculomotor Nerve Diseases; Tomography, X-Ray Computed

We report a case of a 73-year-old patient with complete ophthalmoplegia following an episode of ophthalmic herpes zoster. MRI showed an associated ipsilateral temporal meningioma with cavernous sinus extension. We discuss the possible responsibility of these two conditions in the ocular motor signs.

Topics: Acyclovir; Aged; Anisocoria; Anti-Inflammatory Agents; Antiviral Agents; Blepharoptosis; Brain Neoplasms; Female; Herpes Zoster Ophthalmicus; Humans; Magnetic Resonance Imaging; Meningioma; Methylprednisolone; Ophthalmoplegia; Temporal Lobe; Valacyclovir; Valine; Visual Acuity

Only few studies focus on ocular motor paralyses in herpes zoster ophtalmicus. We report 2 cases of complete ptosis resulting from paralysis of the superior lid levator, appearing at day 6 and 7 of an ophtalmic herpes zoster under treatment with acyclovir.. Case 1: A 68 year old woman presented an history of ophtalmic herpes zoster with kerato-conjunctivitis and uveitis treated with acyclovir. At the third day of the treatment and 7th day of the ophtalmic zoster, an incomplete paralysis of the oculomotor nerve appeared resulting in a complete ptosis. The treatment was carried on until the 21st day without improvement. Four months later, all symptoms had completely cleared. CASE 2: A 66 year old woman was treated with acyclovir for an ophtalmic herpes zoster without ocular involvement. At the 4th day of the treatment and 6th day of the onset of the ophtalmic zoster, a paralytic ptosis and a acute epithelial keratitis appeared. Acyclovir treatment was continued for 10 days. The ptosis resolved gradually during 2 months.. The manifestation of a complete ptosis with paralysis of the oculomotor nerve or of one of its branch is rarely seen in ophtalmic herpes zoster. However minor symptoms are often detected when patients were carefully examined with regard to external ocular movements. The physiopathological mechanism are discussed about. The possible action of an early antiviral treatment on the prevention of these complications is not known. In our two cases, a paralytic ptosis broke out suddenly, even under treatment with acyclovir for respectively 3 and 4 days. For future prospective studies about antiviral drugs for ophtalmic herpes zoster, a systematic evaluation of these neurological symptoms would be interesting.

Topics: Acyclovir; Aged; Antiviral Agents; Blepharoptosis; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Oculomotor Nerve Diseases