acyclovir and Diplopia

Progressive outer retinal necrosis is a necrotizing herpetic retinopathy usually seen in immunocompromised patients. The authors describe two patients with this disease who initially had findings suggestive of an optic neuropathy. Vision declined after treatment with methylprednisolone, after which fundus examination became consistent with progressive outer retinal necrosis. These cases underscore the importance of careful examination of the retinal periphery before management of any presumed optic neuropathy with steroids.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus Infections; Cytomegalovirus Retinitis; Diagnostic Errors; Diplopia; Disease Progression; Encephalitis, Viral; Female; Foscarnet; Herpes Zoster; Humans; Magnetic Resonance Imaging; Methylprednisolone; Middle Aged; Necrosis; Optic Neuritis; Paresis; Prednisone; Retina

Topics: Abducens Nerve Diseases; Acyclovir; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Celecoxib; Diplopia; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Prednisone; Pregabalin

Topics: Acyclovir; Administration, Intravenous; Adult; Antiviral Agents; Diplopia; Female; Herpesvirus 3, Human; Humans; Stroke; Treatment Outcome; Varicella Zoster Virus Infection

A 66-year-old man presented with headache and ophthalmalgia. Diplopia developed, and he was hospitalized. The left eye had abducent paralysis and proptosis. We diagnosed him with Tolosa-Hunt syndrome and administered methylprednisolone at 1 g/day for 3 days. However, the patient did not respond to treatment. No abnormality was found on his MRI or cerebrospinal fluid examination. Tests showed his serum immunoglobulin G4 and antineutrophil cytoplasmic antibody titers were within normal limits. He also had untreated diabetes mellitus (HbA1c 9.2). One week after first presenting with symptoms, herpes zoster appeared on the patient's dorsum nasi, followed by keratitis and a corneal ulcer. Herpes zoster ophthalmicus with ophthalmoplegia was diagnosed. We began treatment with acyclovir (15 mg/kg) and prednisolone (1 mg/kg, decreased gradually). Ophthalmalgia and the eruption improved immediately. The eye movement disorder improved gradually over several months. It is rare that diplopia appears prior to cingulate eruption of herpes zoster ophthalmicus. We speculated that onset of the eruption was inhibited by strong steroid therapy and untreated diabetes mellitus.

Topics: Acyclovir; Aged; Diabetes Complications; Diplopia; Drug Therapy, Combination; Eye Pain; Herpes Zoster Ophthalmicus; Humans; Male; Ophthalmoplegia; Prednisolone; Time Factors; Treatment Outcome

Herpes zoster ophthalmicus is rare in healthy children. It is occasionally associated with extraocular muscle palsies and rarely with isolated trochlear nerve palsy. We report a case of unilateral isolated trochlear nerve palsy associated with herpes zoster ophthalmicus in an immunocompetent 13-year-old girl who presented with diplopia and blurred vision in her right eye. The right cornea had multiple subepithelial opacities. Ocular motility returned to normal and diplopia and corneal opacification resolved with steroid therapy. To our knowledge, this is the first such case involving the troclear nerve in a child.

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; Corneal Opacity; Diplopia; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Infusions, Intravenous; Methylprednisolone; Ophthalmic Solutions; Prednisolone; Trochlear Nerve Diseases

To report a unique presentation of 3rd and 6th cranial nerve palsies with nodular scleritis and nummular keratouveitis following an attack of herpes zoster ophthalmicus (HZO).. Case report.. A 56-year-old woman with a 1-month history of HZO presented with drooping of the right upper eyelid, diplopia, and pain around the right eye. She was noted to have right 3rd and 6th cranial nerve palsies. She developed nodular scleritis and nummular keratouveitis at 2 and 4 months follow-up, respectively, which were treated with antivirals and steroids. At 10 months follow-up, although the diplopia in right lateral gaze persisted, there was no recurrence of ocular inflammation with complete recovery of ptosis.. A unique presentation of multiple cranial nerve palsies with nodular scleritis and nummular keratouveitis in an immunocompetent patient following an attack of HZO is highlighted in this report.

Topics: 2-Aminopurine; Abducens Nerve Diseases; Acyclovir; Antiviral Agents; Diplopia; Drug Therapy, Combination; Famciclovir; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Oculomotor Nerve Diseases; Prednisolone; Scleritis; Treatment Outcome; Uveitis

Viral infection is a rare cause of painful ophthalmoplegia. We report on a 67-year-old patient who developed painful double vision after a vesicular skin rash on the left forehead. MRI disclosed simultaneous inflammatory lesions in all extraocular muscles, the second and third cranial nerve, as well as pathological signal intensity along the spinal trigeminal tract and nucleus within the medulla oblongata and the pons. Cerebrospinal fluid and serum tests for varicella zoster were positive. The patient was treated effectively with intravenous acyclovir and methylprednisolone. Simultaneous lesions in various neighbouring neural structures may be characteristic for the highly neurotropic behaviour of the herpesviridae and should be considered as a cause of painful ophthalmoplegia that can be depicted by appropriate imaging.

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Diplopia; Exanthema; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Methylprednisolone; Oculomotor Nerve; Oculomotor Nerve Diseases; Optic Nerve; Optic Nerve Diseases; Orbit; Orbital Myositis; Tolosa-Hunt Syndrome; Trigeminal Nuclei

Topics: Abducens Nerve Diseases; Acyclovir; Administration, Oral; Antiviral Agents; Child; Diplopia; Herpes Zoster Ophthalmicus; Humans; Male

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

To present a case of orbital myositis associated with herpes zoster ophthalmicus.. Observational case report.. A 47-year-old woman with acute retrobulbar eye pain and diplopia preceding the vesicular rash of herpes zoster ophthalmicus was evaluated and treated.. Magnetic resonance imaging showed enlargement and enhancement of extraocular muscles consistent with an inflammatory myopathy. Following acyclovir and prednisone treatment, all symptoms resolved, and neuralgia did not develop.. Herpes zoster may cause symptoms and signs of orbital myositis before eruption of cutaneous skin lesions and thus should be considered in the differential diagnosis of an acute orbital myositis.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Diplopia; Drug Therapy, Combination; Female; Herpes Zoster Ophthalmicus; Humans; Magnetic Resonance Imaging; Middle Aged; Oculomotor Muscles; Orbital Pseudotumor; Pain; Prednisone

Presentation of a 34-year-old pregnant woman with skew deviation due to peripheral vestibular dysfunction caused by herpes zoster oticus.. A multidisciplinary approach (neuroophthalmology, otorhinolaryngology, neuroradiology) revealed the diagnosis of Ramsey-Hunt syndrome.. The patient presented with painful herpes zoster vesicles of the left ear, associated with a rotatory vertigo and hearing loss. Otorhinolaryngological examination showed a unilateral peripheral vestibular loss, a nystagmus towards the unaffected right side, no facial nerve dysfunction and a left perception hearing loss, mainly in the frequencies between 2-6 KHz. The patient was treated with Zovirax IV. Neuroradiological examination (MRI without contrast) revealed no abnormalities. Vertical diplopia from skew deviation was noted +/- 10 days after onset of herpes zoster oticus. Neuroophthalmological and orthoptic examination showed a comitant right hypertropia of 6 diopters and a spontaneous nystagmus to the right.. Skew deviation can be caused by a sudden unilateral cochleo-vestibular loss as described by A.B. Safran. (4,6,7,8).

Topics: Acyclovir; Adult; Diplopia; Female; Herpes Zoster Oticus; Humans; Magnetic Resonance Imaging; Pregnancy; Pregnancy Complications, Infectious