acyclovir and Eye-Injuries

Treatment options for peripheral facial palsy (PFP) are an often discussed problem in neurologic practice. Following a short description of the complex anatomy of the seventh cranial nerve we therefore review possible etiologies in the context of leading clinical signs, with idiopathic PFP or Bell's palsy (BP) being most frequent. A rather typical clinical course of BP allows to focus differential diagnostic workup predominantly on the rapid identification of treatable infections such as with Herpes zoster or Borrelia burgdorferi. Neuroimaging studies are needed only in case of trauma, with slowly developing PFP or in the presence of associated signs and symptoms. As BP is characterized by an overall high rate of spontaneous recovery, major emphasis has to be put on avoiding complications by protecting the eye. Meta-analysis of four randomized controlled studies suggests a marginal benefit of steroids concerning eventual achievement of complete recovery. Beneficial effects of a combination of acyclovir and prednisone have also been claimed. While such therapies may be considered in patients with a presumptive bad prognosis, more general recommendations on medical treatment of BP will have to await further trials.

Topics: Acyclovir; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Antiviral Agents; Clinical Trials as Topic; Diabetic Neuropathies; Diagnosis, Differential; Diagnostic Imaging; Eye Injuries; Facial Nerve; Facial Nerve Injuries; Facial Paralysis; Herpes Simplex; Humans; Neoplasms; Pons; Postoperative Complications; Prednisone; Prognosis; Virus Diseases

Acute retinal necrosis is a severe form of necrotizing retinitis. Acute retinal necrosis has been demonstrated to be caused by varicella-zoster virus and herpes simplex virus type 1. We treated three patients with acute retinal necrosis apparently caused by recrudescence of latent herpes simplex virus type 2. Primary viral infection was probably congenital, with documented perinatal herpes simplex virus type 2 infection in two patients. Bilateral chorioretinal scars were present in two patients, neither of whom had a history of ocular herpetic infection, suggesting that earlier subclinical chorioretinitis had occurred. In each case, periocular trauma preceded the development of retinitis by two to three weeks. These cases are evidently caused by trauma-induced reactivation of latent virus rather than the onset of a primary infection.

Topics: Acyclovir; Adult; Antibodies, Viral; Child; Child, Preschool; DNA, Viral; Eye Infections, Viral; Eye Injuries; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Male; Methylprednisolone; Retinal Necrosis Syndrome, Acute; Virus Activation

We present the case of a 38-year-old man who developed herpes zoster ophthalmicus after orbital blunt trauma. Additional evaluation revealed human immunodeficiency virus type 1 (HIV-1) infection. This case shows that varicella-zoster may be activated by local trauma and that herpes zoster ophthalmicus in young patients may indicate underlying HIV-1 infection.

Topics: Acyclovir; Adult; CD4-CD8 Ratio; Eye Injuries; Herpes Zoster Ophthalmicus; HIV Infections; HIV Seropositivity; HIV-1; Humans; Male; Orbit; Virus Activation