acyclovir and Corneal-Diseases

Herpes zoster ophthalmicus occurs when the varicella-zoster virus is reactivated in the ophthalmic division of the trigeminal nerve. Herpes zoster ophthalmicus represents up to one fourth of all cases of herpes zoster. Most patients with herpes zoster ophthalmicus present with a periorbital vesicular rash distributed according to the affected dermatome. A minority of patients may also develop conjunctivitis, keratitis, uveitis, and ocular cranial-nerve palsies. Permanent sequelae of ophthalmic zoster infection may include chronic ocular inflammation, loss of vision, and debilitating pain. Antiviral medications such as acyclovir, valacyclovir, and famcidovir remain the mainstay of therapy and are most effective in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of herpes zoster ophthalmicus. with referral to an ophthalmologist when ophthalmic involvement is present, are critical in limiting visual morbidity.

Topics: Acyclovir; Antiviral Agents; Blepharitis; Corneal Diseases; Herpes Zoster Ophthalmicus; Humans; Uveitis

Twenty nine published clinical trials with acyclovir (ACV) ophthalmic ointment in the treatment of herpes simplex virus (HSV) corneal disease have been reviewed in which ACV has been demonstrated to be effective in the treatment of simple dendritic ulcers, geographic ulcers, deep corneal HSV infections and ocular disease associated with herpes zoster (VZV) infection affecting the ophthalmic division of the trigeminal nerve. 998 patients were studied. The most commonly occurring adverse reactions were superficial punctate keratopathy (in 9.8% of patients) and burning or stinging on application of the ointment (4%). ACV ophthalmic ointment was first licensed for the treatment of HSV infections of the eye in September 1981. Spontaneous reports of adverse reactions to ACV ophthalmic ointment to both the UK Committee on Safety of Medicines and the Wellcome Group Adverse Reactions Reporting Centre total 43 cases. These include conjunctivitis, inflammation and pain in the treated eye. In this time it is estimated that there have been approximately one million exposures to the ointment. Thus in general use, tolerance to ACV treatment has been extremely good, and clinical trial data demonstrate that it compares favourably with alternative therapies for HSV corneal disease.

Topics: Acyclovir; Clinical Trials as Topic; Corneal Diseases; Drug Tolerance; Eye Diseases; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Ointments

Twenty nine published clinical trials with acyclovir (ACV) ophthalmic ointment in the treatment of herpes simplex virus (HSV) corneal disease have been reviewed in which ACV has been demonstrated to be effective in the treatment of simple dendritic ulcers, geographic ulcers, deep corneal HSV infections and ocular disease associated with herpes zoster (VZV) infection affecting the ophthalmic division of the trigeminal nerve. 998 patients were studied. The most commonly occurring adverse reactions were superficial punctate keratopathy (in 9.8% of patients) and burning or stinging on application of the ointment (4%). ACV ophthalmic ointment was first licensed for the treatment of HSV infections of the eye in September 1981. Spontaneous reports of adverse reactions to ACV ophthalmic ointment to both the UK Committee on Safety of Medicines and the Wellcome Group Adverse Reactions Reporting Centre total 43 cases. These include conjunctivitis, inflammation and pain in the treated eye. In this time it is estimated that there have been approximately one million exposures to the ointment. Thus in general use, tolerance to ACV treatment has been extremely good, and clinical trial data demonstrate that it compares favourably with alternative therapies for HSV corneal disease.

Topics: Acyclovir; Clinical Trials as Topic; Corneal Diseases; Drug Tolerance; Eye Diseases; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Ointments

Acyclovir is an effective and relatively non-toxic antiviral agent which has recently been introduced for the treatment of herpes virus infections in man. When combined with dilute steroid, acyclovir heals herpetic disciform keratitis and preliminary results of a double-blind clinical trial suggest that it may be more effective and less toxic than adenine arabinoside in the treatment of this condition.

Topics: Acyclovir; Betamethasone; Clinical Trials as Topic; Corneal Diseases; Double-Blind Method; Drug Therapy, Combination; Humans; Keratitis, Dendritic; Vidarabine

Current drug-delivery systems are designed primarily for parenteral applications and are either lipid or polymer drug conjugates. In our quest to inhibit herpes simplex virus infection via the compounds found in commonly used cosmetic products, we found that activated carbon particles inhibit infection and, in addition, substantially improve topical delivery and, hence, the efficacy of a common antiviral drug, acyclovir (ACV). Our in vitro studies demonstrate that highly porous carbon structures trapped virions, blocked infection and substantially improved efficacy when ACV was loaded onto them. Also, using murine models of corneal and genital herpes infections, we show that the topical use of drug-encapsulated carbon (DECON) reduced dosing frequency, shortened treatment duration, and exhibited higher therapeutic efficacy than currently approved topical or systemic antivirals alone. DECON is a nontoxic, cost-effective and nonimmunogenic alternative to current topical drug-delivery systems that is uniquely triggered for drug release by virus trapping.

Topics: Acyclovir; Animals; Antiviral Agents; Carbon; Cell Line, Tumor; Charcoal; Chlorocebus aethiops; CHO Cells; Corneal Diseases; Cricetulus; Disease Models, Animal; Drug Carriers; Female; HeLa Cells; Herpes Genitalis; Herpesvirus 1, Human; Humans; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Vero Cells

To review the long-term outcomes of penetrating keratoplasty (PKP) for corneal complications of herpes zoster ophthalmicus (HZO).. We reviewed the medical records of 53 eyes of 53 patients who underwent PKP due to corneal complications of HZO at the Kellogg Eye Center.. The mean age of patients at the time of PKP was 68.0±16.4 years, with a follow-up of 4.0±3.8 years and quiescent period of 6.5±5.3 years from active HZO to PKP. Preoperatively, 25 (47.2%) eyes were completely anaesthetic, while 16 (30.2%) had deep corneal neovascularisation in four quadrants. Comorbid ocular disease, including cataract, glaucoma and macular disease, was present in 25 (47.2%) eyes. Twenty patients (37.8%) received acyclovir for the entire postoperative period. There were no recurrences of zoster keratitis in any eye. The most common complications were difficulty healing the ocular surface (12/53, 22.6%) and glaucoma (14/53, 26.4%). Thirty per cent of the eyes required one or more additional postoperative procedures, most commonly tarsorrhaphy (10/53, 18.9%) and amniotic membrane graft (6/53, 11.3%). At 1, 2-4 and ≥5 years, 94%, 82% and 70% grafts remained clear, respectively. Visual acuity improved at 1 year postoperatively (p<0.0001), but this improvement was not sustained. There was no significant benefit of long-term acyclovir on visual acuity (p=0.2132) or graft survival (p=0.241).. Even in eyes with significant preoperative risk factors, PKP for the corneal complications of HZO can achieve favourable tectonic and visual results. Although most grafts remained clear, long-term visual potential may be limited by comorbid ocular diseases. Prophylactic postoperative oral acyclovir did not improve outcomes.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Corneal Diseases; Eye Infections, Viral; Female; Follow-Up Studies; Graft Survival; Herpes Zoster Ophthalmicus; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome; Visual Acuity

A young lactating woman presenting to us with simultaneous bilateral corneal lesions was clinically diagnosed to have herpes simplex keratitis, which was confirmed by herpes simplex virus (HSV) PCR. The patient was administered topical and systemic acyclovir therapy and therapeutic penetrating keratoplasty was done in right eye. She was advised to continue breast feeding under strict hygienic conditions. Diagnosis and management of HSV keratitis in a lactating patient can be particularly challenging for both clinician and patient and adoption of a multidisciplinary approach is necessary to ensure safety of mother and child. At 3 months follow-up, the baby was clinically healthy, there were no side effects of acyclovir therapy in the mother or the baby and the patient showed no evidence of recurrence in either eye.

Topics: Acyclovir; Aftercare; Antiviral Agents; Breast Feeding; Corneal Diseases; Diagnosis, Differential; Female; Herpesviridae Infections; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Lactation; Rare Diseases; Treatment Outcome; Young Adult

Eczema herpeticum is a rare and potentially life-threatening viral infection. We present the case of a 54-year-old man who presented to the emergency eye clinic with a dendritic ulcer and a facial rash. An initial diagnosis of herpes zoster ophthalmicus was suspected. On follow-up, the rash had begun to rapidly disseminate and was no longer respecting dermatome boundaries. A diagnosis of eczema herpeticum was made and appropriate treatment started. This case highlights the importance of a comprehensive history and close inspection of skin lesions in patients with herpetic eye disease.

Topics: Acyclovir; Antiviral Agents; Corneal Diseases; Dermatitis, Atopic; Diagnosis, Differential; Humans; Kaposi Varicelliform Eruption; Male; Middle Aged; Treatment Outcome

Bell's palsy is an idiopathic unilateral paresis or paralysis of the facial nerve. The authors describe a 3-month-old infant with Bell's palsy and detail the investigation and management appropriate for the pediatric age group.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Corneal Diseases; Drug Therapy, Combination; Facial Muscles; Female; Glucocorticoids; Humans; Infant; Prednisolone; Recovery of Function

Topics: Acyclovir; Antiviral Agents; Corneal Diseases; Drug Resistance, Viral; Foscarnet; Humans; Keratitis, Herpetic; Treatment Failure; Treatment Outcome; Vidarabine

Corneal involvement in maxillary herpes zoster is very rare. This report presents the case of a 32 years old 7 months pregnant para2+1 female, who presented with vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the face on the left side with periocular oedema, conjunctivitis and mild punctate keratitis in the left eye. She was HIV positive and was on treatment with the highly active antiretroviral therapy. She was treated with topical and systemic acyclovir with rapid resolution of the ocular features.

Topics: Acyclovir; Adult; Antiretroviral Therapy, Highly Active; Antiviral Agents; Corneal Diseases; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Maxillary Nerve; Ophthalmic Nerve; Pregnancy; Pregnancy Complications, Infectious

To report a series of patients with no previous history of herpes simplex virus (HSV) infection who had new onset of herpetic keratitis after penetrating keratoplasty (PK).. Noncontrolled, retrospective case series.. We included in the study the patients who had new onset of herpetic keratitis after penetrating keratoplasty for corneal diseases unrelated to HSV infection who were seen at the Cornea Service at Wills Eye Hospital (Philadelphia, Pennsylvania) from January 1996 to December 2002. The diagnosis of HSV epithelial keratitis was based on clinical characteristics of either a classic herpetic dendrite, a geographic ulcer, or a nonhealing epithelial defect that responded only to antiviral therapy.. Fourteen patients were included in the study. Eight of these (57%) had presented with a geographic ulcer whereas six patients (43%) had a classic dendrite. The most common primary corneal disease that led to PK was pseudophakic bullous keratopathy (36%), followed by keratoconus (29%), Fuchs dystrophy (21%), and corneal scar unrelated to HSV (14%).. The ophthalmologist should be aware of the possibility of herpetic keratitis in eyes after PK, even in patients with no previous history of HSV infection.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Aged; Antiviral Agents; Corneal Diseases; Epithelial Cells; Epithelium, Corneal; Female; Humans; Keratitis, Dendritic; Keratoplasty, Penetrating; Male; Middle Aged; Recurrence; Retrospective Studies; Trifluridine

The purpose of this case series was to present an overview of the nature and frequency of ocular complications in the Department of Defense (DoD) Smallpox Vaccination Program.. Retrospective, noncomparative case series.. The authors retrospectively evaluated data collected on individuals with an ophthalmologic complaint after receiving smallpox vaccination or after contact with a recently immunized individual. The vaccinee and contact cases occurred secondary to inoculations given between December 13, 2002 and May 28, 2003 as part of the DoD Smallpox Vaccination Program.. Data were collected primarily from reports to military headquarters or to the Vaccine Adverse Event Reporting System and individual medical records.. The incidence, types, and timing of ocular complications were evaluated. Diagnostic and treatment considerations also were reviewed.. Between December 13, 2002 and May 28, 2003, 450,293 smallpox vaccinations were given. We identified 16 confirmed or probable cases of ocular vaccinia, with an incidence of 3.6 per 100,000 inoculations. Of these cases, 12 (75%) were seen in the vaccinees, and 4 (25%) in close contacts. Of the 12 self-inoculation cases, 7 (58.3%) were seen in individuals receiving the vaccine for the first time (primary vaccination), and 3 (25.0%) were seen in individuals previously vaccinated (revaccination); the vaccination status in 2 cases was unknown. Clinical manifestations included lid pustules, blepharitis, periorbital cellulitis, conjunctivitis, conjunctival ulcers, conjunctival membranes, limbal pustules, corneal infiltrates, and iritis, with onset of symptoms 3 to 24 days after inoculation or contact. Five of 9 tested cases were culture or polymerase chain reaction positive for vaccinia. Treatment for most cases was topical trifluridine 1% (Viroptic; King Pharmaceuticals, Inc., Bristol, TN). Vaccinia immune globulin was used in 1 case. In all patients, recovery occurred without significant visual sequelae.. When compared with historical data on the ocular complications of smallpox vaccination, the incidence of ocular complications during the DoD Smallpox Vaccination program has been low. In addition, the severity of disease seems to be less than during other vaccination periods. These findings perhaps are the result of improved screening of vaccinees, prevaccination counseling, postvaccination wound care, and the suggested efficacy of trifluridine in the treatment of ocular vaccinia.

Topics: Acyclovir; Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Antiviral Agents; Conjunctival Diseases; Corneal Diseases; Eye Infections, Viral; Eyelid Diseases; Female; Humans; Immunization Programs; Incidence; Infection Control; Male; Middle Aged; Military Medicine; Military Personnel; Retrospective Studies; Smallpox Vaccine; Trifluridine; United States; Vaccination; Vaccinia

To report an unusual case of herpetic bullous keratitis misdiagnosed as a case of pseudophakic bullous keratopathy with secondary glaucoma.. A retrospective analysis of the case record of a 60-year-old man who had earlier undergone bilateral cataract surgery, was done. He presented with a complaint of decrease in vision in the right eye of 20 days duration. On examination, cornea showed epithelial bullae all over the surface with stromal and epithelial edema. Intraocular pressure was 30 mm of Hg in RE. He was treated with anti-glaucoma medications. Two dendritic lesions were seen in the cornea during a subsequent visit four days later. Virological investigations confirmed a diagnosis of Herpes simplex keratitis. He was treated with topical acyclovir.. This case highlights the fact that herpes simplex keratitis can present initially as a more diffuse corneal stromal and epithelial edema with epithelial bullae mimicking bullous keratopathy. Herpetic bullous keratitis, although unusual, should be considered in the differential diagnosis under such circumstances.

Topics: Acyclovir; Antiviral Agents; Cornea; Corneal Diseases; Corneal Edema; Corneal Stroma; Diagnostic Errors; Giant Cells; Glaucoma; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Male; Middle Aged; Pseudophakia; Retrospective Studies

To describe a unique case of retrocorneal membrane with large Descemet's detachment.. Case report of a 65-year-old man reported intermittent cloudy vision in his left eye. The patient underwent serial ocular examinations and slit-lamp photography over 6 weeks.. The patient had an inflammatory-appearing membrane that covered 60% of the posterior cornea, with a subtotal Descemet's detachment. Vision was stable at 20/20, and the cornea remained clear. The patient was empirically treated with topical neomycin/polymyxin/dexamethasone, sodium chloride, and oral acyclovir, and his symptoms improved; however, the retrocorneal membrane persisted.. This unusual clinical finding may represent reduplicated Descemet's membrane with partial Descemet's detachment secondary to occult deep herpes simplex keratitis. Other possibilities include spontaneous or traumatic Descemet's tear and detachment.

Topics: Acyclovir; Aged; Corneal Diseases; Descemet Membrane; Dexamethasone; Drug Therapy, Combination; Humans; Keratitis, Herpetic; Male; Neomycin; Polymyxins

Certain drugs bind to anionic phospholipids of lysosomal membranes and produce progressive intracellular accumulation of lamellar inclusions. We studied two patients treated for opportunistic infections associated with the acquired immunodeficiency syndrome (AIDS), who developed bilateral ocular surface changes suggestive of drug-induced corneal lipidosis.. Two patients with AIDS had translucent vacuoles within the corneal epithelium and mild conjunctival hyperemia. Because the differential diagnosis included microsporidial keratoconjunctivitis, biopsies of the ocular surface were performed for histopathologic analysis.. Transmission electron microscopy of corneal epithelial debridement and conjunctival biopsy specimens showed intracellular, electron-dense lipoidal bodies and multilaminated lysosomal inclusions suggestive of a drug-induced lipidosis. Both patients also had tubuloreticular inclusions in conjunctival capillary endothelial cells. The ocular surface changes resolved within one to three months after dosage reduction or discontinuation of systemic ganciclovir and acyclovir.. Drug-induced phospholipidosis is a cause of punctate corneal epitheliopathy during AIDS, but the responsible agent remains to be identified.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Biopsy; Cornea; Corneal Diseases; Ganciclovir; Humans; Lipidoses; Male

The role of oral acyclovir (ACV) in the management of immunocompetent patients with herpes zoster ophthalmicus remains controversial. We have performed a retrospective, comparative, case-control study of cases seen in the Zoster Clinic at Moorfields Eye Hospital over the last 5 years. A standard proforma was used during this period to collect data on the rash, ocular involvement and treatment. There were 419 immunocompetent patients of whom 77 were treated with oral ACV prior to attending the clinic. We compared these with paired controls matched for age, sex and severity of rash. No difference in the rate of ocular complications between treated and untreated patients could be detected. This suggests that oral ACV as currently prescribed has little or no preventive effect on the ocular complications of ophthalmic zoster.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Aged, 80 and over; Case-Control Studies; Corneal Diseases; Female; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Male; Middle Aged; Retrospective Studies; Scleritis; Treatment Outcome; Uveitis, Anterior

Corneal complications of herpes zoster ophthalmicus include pseudodendritic keratitis, late mucous adherent keratopathy, varied forms of stromal keratitis, and exposure/neurotrophic keratopathy. Prophylactic therapy of acute herpes zoster ophthalmicus with oral acyclovir is of proven benefit in reducing the incidence of early pseudodendritic keratopathy and stromal keratitis but has no evident effect on exposure/neurotrophic keratopathy. Although early pseudodendritic keratitis is due to virus infection of epithelial cells, it is self-limited and does not require topical antiviral therapy. Stromal keratitis and associated epithelial mucous adherent keratopathy are responsive to topical corticosteroids but chronic therapy is often required and may prolong the duration of keratitis and result in cataract or secondary glaucoma. Exposure and neurotrophic keratopathy may respond to topical lubricants and correction of lid abnormalities but severely affected corneas may require tarsorrhaphy or conjunctival flap to maintain corneal integrity.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adrenal Cortex Hormones; Antiviral Agents; Cornea; Corneal Diseases; Corneal Stroma; Herpes Zoster Ophthalmicus; Humans; Keratitis; Lubrication

Various side effects due to antiherpetic drugs observed in the last ten years in our department were studied. A total of 132 patients were treated with 5-iodo-2'-deoxyuridine (IDU), 69 with trifluorothymidine (F3T), 58 with acyclovir (ACV) and 33 with adenine arabinoside (ara-A). Patch tests were routinely done when patients exhibited contact dermatitis. Of the patients treated with IDU, 3 (2.3%) showed contact dermatitis, 2 (1.5%) follicular conjunctivitis and 1 (0.8%) punctate keratopathy. Of the patients treated with F3T, 7 (10.1%) exhibited contact dermatitis and 1 (1.4%) follicular conjunctivitis. In the group treated with ACV, 2 (3.4%) patients showed punctate keratopathy. The patients who received ara-A did not show any side effects. We found that F3T caused contact dermatitis more frequently in Japanese people than Europeans. These side effects were resolved by switching to another anti-herpetic drug without the occurrence of cross-allergy. Therefore, switching to another drug is strongly recommended when patients exhibit side effects in the treatment of herpetic keratitis. Other complications were allergy to atropine and to drug preservative.

Topics: Acyclovir; Conjunctivitis; Corneal Diseases; Dermatitis, Contact; Humans; Idoxuridine; Keratitis, Dendritic; Thymidine; Trifluridine; Vidarabine