acyclovir and Dry-Eye-Syndromes

To describe a case of nivolumab-induced ulcerative keratitis rapidly recovering on topical steroid treatment and to determine changes in cytokine levels in the tear fluid caused by nivolumab.. We report a 34-year-old man receiving nivolumab for metastasized melanoma with severe dry eye symptoms and a persistent corneal epithelial defect. Levels of cytokine and matrix metalloproteinase in tear fluid were measured by multiplex immunoassays.. The corneal epithelial defect failed to recover for antiviral and lubrication therapy but resolved within 48 hours after topical steroid therapy was initiated. No recurrence of corneal ulceration was observed with intermittent topical steroid therapy during the remaining period of nivolumab treatment. No Sjögren disease-related autoantibodies were detected in the patient's serum. The levels of inflammatory cytokines and matrix metalloproteinases in the tear fluid were markedly elevated after nivolumab treatment.. Our observations suggest that nivolumab treatment induces a local autoimmune ocular surface disorder resulting in corneal ulceration that promptly resolves using steroid eye drops. The integrity of the corneal epithelial layer can be sustained using intermittent topical steroid therapy in patients receiving nivolumab.

Topics: Acyclovir; Adult; Antiviral Agents; Corneal Ulcer; Cytokines; Dry Eye Syndromes; Humans; Immune Checkpoint Inhibitors; Immunoassay; Male; Matrix Metalloproteinases; Melanoma; Nivolumab; Skin Neoplasms; Tears

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Combined Modality Therapy; Corneal Stroma; Cyclosporine; Drug Therapy, Combination; Dry Eye Syndromes; Electrocoagulation; Eyelids; Glucocorticoids; Herpesvirus 1, Human; Humans; Immunosuppressive Agents; Keratitis, Herpetic; Lacrimal Apparatus; Secondary Prevention; Valacyclovir; Valine; Virus Activation

To evaluate the efficacy of adjunctive treatments to decrease herpes simplex keratitis (HSK) recurrences in patients with simultaneous stromal HSK and dry eye disease.. This was a nonrandomized, single-center, retrospective, comparative analysis. Forty-two patients were diagnosed with unilateral HSK and dry eye disease. Of the 42 patients, 22 were treated with ipsilateral punctal occlusion by thermal cautery and 10 were treated with topical administration of cyclosporine, 0.05%, ophthalmic emulsion twice a day. Another group of 10 patients had previously undergone punctal occlusion and had cyclosporine ophthalmic emulsion twice a day added. All patients continued the use of oral acyclovir or valacyclovir hydrochloride and topical steroids. The frequency and duration of HSK recurrences were monitored for 1 year after initiation of treatment, and the rates were compared with those in the prior year.. The thermal cautery and topical cyclosporine groups experienced HSK recurrences for mean durations of 7.1 and 5.8 mo/y before treatment, respectively, and these were reduced to 1.1 mo/y after treatment in both groups. Topical administration of cyclosporine further reduced the duration of HSK recurrences in patients with prior thermal cautery from an average of 1.3 mo/y before the addition of cyclosporine to 0.8 mo/y after the addition of cyclosporine.. Permanent punctal occlusion by thermal cautery and the use of topical cyclosporine independently reduced recurrences of stromal HSK.

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Combined Modality Therapy; Corneal Stroma; Cyclosporine; Drug Therapy, Combination; Dry Eye Syndromes; Electrocoagulation; Eyelids; Glucocorticoids; Herpesvirus 1, Human; Humans; Immunosuppressive Agents; Keratitis, Herpetic; Lacrimal Apparatus; Retrospective Studies; Secondary Prevention; Valacyclovir; Valine; Virus Activation

Bell"s palsy is a neuropathy of the peripheral seventh cranial nerve, resulting from traumatic, compressive, infective, inflammatory or metabolic abnormalities or it can be idiopathic. HIV, Epstein-Barr virus and hepatitis B virus have been suspected as initiating organisms, but herpes simplex virus is the most frequently implicated. This report describes 2 cases of Bell"s palsy in children that were managed with antiviral agents. Both patients experienced complete recovery within 28 days; after 1 year follow-up, no recurrence was observed and both patients have normal facial movement. Differential diagnosis is essential to guide the treatment plan in Bell"s palsy. Special attention should be given to children with respect to prescription of medications that can cause important side effects.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Child; Diagnosis, Differential; Dry Eye Syndromes; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Ophthalmic Solutions; Virus Activation