acyclovir and Exophthalmos

A male patient with herpes zoster ophthalmicus (HZO) presented with left exophthalmos, external and internal ophthalmoplegia and decreased visual acuity. A CT scan revealed myositis without significant compression of the optic nerve. Intravenous acyclovir and oral steroids were started with improvement of the symptoms and eventual complete recovery.Orbital apex syndrome is a rare complication of HZO. Multiple pathogenic mechanisms are involved, including a direct cytopathic effect of the virus as in the present case. Early diagnosis and therapy may lead to complete recovery of visual function.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Exophthalmos; Herpes Zoster Ophthalmicus; Humans; Male; Methylprednisolone; Middle Aged; Ophthalmoplegia; Orbital Myositis; Syndrome; Tomography, X-Ray Computed

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

To present a unique case in which orbital inflammation, proptosis, and optic neuritis were the initial symptoms of acute retinal necrosis (ARN). The clinical presentation of ARN, as well as the currently recommended diagnostic procedures and guidelines for medical treatment of ARN, are summarized.. Interventional case report.. Polymerase chain reaction (PCR) techniques were made on the vitreous for cytomegalovirus, Epstein-Barr virus, herpes simplex virus (HSV), varicella zoster virus, and toxoplasmosis. A full laboratory evaluation was made together with HLA-typing and serologic tests measuring convalescent titers for HSV and other micro-organisms. Magnetic resonance imaging scan, computed tomography (CT) scan, and fluorescein angiographic examination were performed. The patient was treated with acyclovir and oral prednisone.. The patient was evaluated for initial and final visual acuity and for degree of proptosis, periocular edema, and vitreitis.. The first symptoms and signs of ARN were eye pain, headache, proptosis, and a swollen optic nerve on CT scan. Other than increased C-reactive protein, all blood samples were normal. PCR was positive for HSV-type I in two separate vitreous biopsies. The patient had the strongly ARN-related specificity HLA-DQ7.. This is the first report of HSV-induced ARN presenting with inflammatory orbitopathy and optic neuritis. Polymerase chain reaction for HSV-1 was positive more than 4 weeks after debut of symptoms, which is a new finding. The combination of severe vitreitis and retinal whitening, with or without proptosis, should alert the clinician to the possibility of herpes infection and treatment with intravenous acyclovir started promptly.

Topics: Acyclovir; Adult; Antibodies, Viral; DNA, Viral; Exophthalmos; Eye Infections, Viral; Female; Fluorescein Angiography; Herpes Simplex; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Optic Neuritis; Orbital Pseudotumor; Polymerase Chain Reaction; Prednisolone; Retinal Necrosis Syndrome, Acute; Tomography, X-Ray Computed; Vitreous Body

Herpes zoster ophthalmicus (HZO) commonly causes isolated ophthalmoplegic syndromes. Visual loss caused by optic neuritis secondary to HZO can be reversible or irreversible. HZO rarely presents as an orbital apex syndrome, when an association with meningo-encephalitis has been reported. We report a case of orbital apex syndrome secondary to HZO treated with systemic steroids and acyclovir. Our patient suffered no systemic complications and displayed a rapid resolution of optic neuropathy. We discuss this case in the light of previous reports and explore the possible pathogenic mechanisms involved.

Topics: Acyclovir; Administration, Oral; Exophthalmos; Female; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Oculomotor Muscles; Optic Nerve Diseases; Orbital Diseases; Prednisone; Syndrome; Tomography, X-Ray Computed