acyclovir and Herpes-Zoster-Ophthalmicus

Topics: Abducens Nerve Diseases; Acyclovir; Aged; Antiviral Agents; Cranial Nerve Diseases; Epithelium, Corneal; Eye Infections, Viral; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Male; Ocular Motility Disorders; Oculomotor Nerve Diseases; Optic Nerve Diseases; Orbital Diseases; Prednisolone; Trigeminal Nerve Diseases; Trochlear Nerve Diseases

To define a clinically tailored therapeutic strategy for the treatment of viral anterior uveitis (VAU).. A PubMed search spanning the past 5 years was conducted using the MesH-terms "viral anterior uveitis" and "therapy.". The herpes simplex virus (HSV), the varicella zoster virus (VZV), and the cytomegalovirus (CMV) are the predominant pathogens in VAU. Other viruses, including rubella, chikungunya, and zika, have been linked with distinct forms of the disease. Depending on the causative agent and the host immunocompetence, the mainstay treatment for suspected VAU is a combination of topical or systemic antivirals and topical corticosteroids, supplemented with cycloplegics and intraocular-pressure-lowering medication.. Oral acyclovir, valacyclovir, and famciclovir are the mainstay of treatment for HSV- and VZV-induced infections. Brivudin serves as an alternative in insufficiently responsive cases. CMV-induced infections respond well to valganciclovir. A 3- to 12-month course of prophylactic treatment against recurrences is worth considering.

Topics: Acyclovir; Antiviral Agents; Bromodeoxyuridine; Chikungunya Fever; Cytomegalovirus Infections; Eye Infections, Viral; Famciclovir; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Rubella; Uveitis, Anterior; Valacyclovir; Zika Virus Infection

To evaluate the available evidence in peer-reviewed publications about the diagnosis and treatment of acute retinal necrosis (ARN).. Literature searches of the PubMed and Cochrane Library databases were last conducted on July 27, 2016. The searches identified 216 unique citations, and 49 articles of possible clinical relevance were reviewed in full text. Of these 49 articles, 27 were deemed sufficiently relevant or of interest, and they were rated according to strength of evidence. An additional 6 articles were identified from the reference lists of these articles and included. All 33 studies were retrospective.. Polymerase chain reaction (PCR) testing of aqueous or vitreous humor was positive for herpes simplex virus (HSV) or varicella zoster virus (VZV) in 79% to 100% of cases of suspected ARN. Aqueous and vitreous specimens are both sensitive and specific. There is level II and III evidence supporting the use of intravenous and oral antiviral therapy for the treatment of ARN. Data suggest that equivalent plasma drug levels of acyclovir can be achieved after administration of oral valacyclovir or intravenous acyclovir. There is level II and III evidence suggesting that the combination of intravitreal foscarnet and systemic antiviral therapy may have greater therapeutic efficacy than systemic therapy alone. The effectiveness of prophylactic laser or early pars plana vitrectomy (PPV) in preventing retinal detachment (RD) remains unclear.. Polymerase chain reaction testing of ocular fluid is useful in supporting a clinical diagnosis of ARN, but treatment should not be delayed while awaiting PCR results. Initial oral or intravenous antiviral therapy is effective in treating ARN. The adjunctive use of intravitreal foscarnet may be more effective than systemic therapy alone. The role of prophylactic laser retinopexy or early PPV is unknown at this time.

Topics: Academies and Institutes; Acyclovir; Antiviral Agents; Aqueous Humor; Biomedical Technology; DNA, Viral; Eye Infections, Viral; Foscarnet; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Ophthalmology; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Simplexvirus; United States; Valacyclovir; Valine; Vitrectomy; Vitreous Body

Herpes zoster ophthalmicus affects the eye and vision, and is caused by the reactivation of the varicella zoster virus in the distribution of the first division of the trigeminal nerve. An aggressive management of acute herpes zoster ophthalmicus with systemic antiviral medication is generally recommended as the standard first-line treatment for herpes zoster ophthalmicus infections. Both acyclovir and its prodrug valacyclovir are medications that are approved for the systemic treatment of herpes zoster. Although it is known that valacyclovir has an improved bioavailability and steadier plasma concentration, it is currently unclear as to whether this leads to better treatment results and less ocular complications.. To assess the effects of valacyclovir versus acyclovir for the systemic antiviral treatment of herpes zoster ophthalmicus in immunocompetent patients.. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2016, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), Web of Science Conference Proceedings Citation Index-Science (CPCI-S; January 1990 to June 2016), BIOSIS Previews (January 1969 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 June 2016.. We considered all randomised controlled trials (RCTs) in which systemic valacyclovir was compared to systemic acyclovir medication for treatment of herpes zoster ophthalmicus. There were no language restrictions.. Two review authors independently selected trials, evaluated the risk of bias in included trials, and extracted and analysed data. We did not conduct a meta-analysis, as only one study was included. We assessed the certainty of the evidence for the selected outcomes using the GRADE approach.. One study fulfilled the inclusion criteria. In this multicentre, randomised double-masked study carried out in France, 110 immunocompetent people with herpes zoster ophthalmicus, diagnosed within 72 hours of skin eruption, were treated, with 56 participants allocated to the valacyclovir group and 54 to the acyclovir group. The study was poorly reported and we judged it to be unclear risk of bias for most domains.Persistent ocular lesions after 6 months were observed in 2/56 people in the valacyclovir group compared with 1/54 people in the acyclovir group (risk ratio (RR) 1.93 (95% CI 0.18 to 20.65); very low certainty evidence. Dendritic ulcer appeared in 3/56 patients treated with valacyclovir, while 1/54 suffered in the acyclovir group (RR 2.89; 95% confidence interval (CI) 0.31 to 26.96); very low certainty evidence), uveitis in 7/56 people in the valacyclovir group compared with 9/54 in the acyclovir group (RR 0.96; 95% CI 0.36 to 2.57); very low certainty evidence). Similarly, there was uncertainty as to the comparative effects of these two treatments on post-herpetic pain, and side effects (vomiting, eyelid or facial edema, disseminated zoster). Due to concerns about imprecision (small number of events and large confidence intervals) and study limitations, the certainty of evidence using the GRADE approach was rated as low to very low for the use of valacyclovir compared to acyclovir.. This review included data from only one study, which had methodological limitations. As such, our results indicated uncertainty of the relative benefits and harms of valacyclovir over acyclovir in herpes zoster ophthalmicus, despite its widespread use for this condition. Further well-designed and adequately powered trials are needed. These trials should include outcomes important to patients, including compliance.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Randomized Controlled Trials as Topic; Valacyclovir; Valine

The objective of this study was to present a unique case of unilateral facial nerve palsy as an isolated complication of herpes zoster ophthalmicus. An 82-year-old immunocompetent male presented with a 1-week history of painful left scalp lesions. The diagnosis of left herpes zoster ophthalmicus with associated keratoconjunctivitis was established. A 7-day course of oral acyclovir (800 mg/day) along with topical prednisolone acetate 1% and moxifloxacin were started. Three weeks later, the ocular zoster involvement resolved and the vesicular lesions of the skin had regressed. However, the patient developed an isolated left Bell's palsy that gradually improved with conservative therapy. To the best of our knowledge, we present an unusual case of herpes zoster ophthalmicus complicated by an isolated ipsilateral Bell's palsy. The patient has had a near complete resolution of all symptoms after antiviral therapy for the zoster ophthalmicus component along with conservative management for the Bell's palsy.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Keratoconjunctivitis; Male; Prednisolone

Topics: Acyclovir; Antiviral Agents; Erythema; Facial Dermatoses; Facial Pain; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Intracranial Hemorrhages; Male; Middle Aged; Radiography; Treatment Outcome

Based on a review of 20 well-documented cases reported in the English literature between 1968 and 2008, herpes zoster ophthalmicus (HZO) may rarely be associated with complete unilateral ophthalmoplegia, defined here as impaired ocular ductions in all 4 directions within 3 months of onset of manifestations of HZO. Ophthalmoplegia occurred equally in immune-competent and immune-incompetent individuals. HZO preceded ophthalmoplegia in 75% by a mean interval of 9.5 days and a range of 2 to 60 days, occurred simultaneously with ophthalmoplegia in 20%, and followed by 2 days the onset of ophthalmoplegia in only 5%. Concurrent conjunctival inflammation, keratitis, or anterior uveitis was present in 90%. Lumbar puncture showed features of aseptic meningitis in 88%, slightly more than the 40%-50% found in patients with HZO without ophthalmoplegia. On orbit/brain imaging, abnormal enlargement of the extraocular muscles was present in 33%, and orbital soft tissue swelling was present in 17%. Enhancement of ocular motor cranial nerves was not reported. Complete or near-complete resolution of ophthalmoplegia occurred in 65% within a range of 2 weeks to 1.5 years (mean 4.4 months). A single autopsy report described granulomatous angiitis of the meninges and large vessels in the anterior cerebral circulation, as well as periaxial infarction in the optic nerve, pons, and medulla but without viral inclusion bodies or antigen. Unsettled issues are whether the pathogenesis is direct viral invasion or an immune reaction to the virus, whether the impaired ocular ductions are based on myopathic or neuropathic injury, whether there are predisposing factors to the combination of HZO and complete ophthalmoplegia, and whether treatment is effective.

Topics: Acyclovir; Adrenal Cortex Hormones; Drug Therapy, Combination; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Ophthalmoplegia; Treatment Outcome

Topics: Acetaminophen; Acyclovir; Administration, Oral; Adult; Aged; Analgesics, Non-Narcotic; Antiviral Agents; Chickenpox; Child, Preschool; Female; Herpes Simplex; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Infant, Newborn; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Recurrence; Seroepidemiologic Studies; Valacyclovir; Valine

Evaluation of evidence-based strategies for managing herpes zoster (HZ) and the pain of postherpetic neuralgia (PHN).. Approximately 20% of the world's population suffers from herpes zoster at least once in a lifetime, with 10% to 20% having ophthalmic involvement. Treatment of the acute disease with oral antivirals may reduce the incidence and severity of complications but does not reliably prevent PHN or postherpetic itch (PHI). The acute pain abates as the acute phase resolves; the long-term pain of PHN or PHI may be severe and difficult to manage. Although many therapeutic agents have efficacy in the management of these complications, relief is frequently partial for months to the remainder of the lifetime.. Literature review was performed using the resources of the Harvard Medical School/Massachusetts Eye and Ear Infirmary Ophthalmic library as well as the National Library of Medicine and the National Institutes of Health PubMed service searching by pertinent topics, authors, and journals.. If started within 72 hours of the onset of the acute HZ rash, the oral antiviral agents acyclovir, valacyclovir, and famciclovir significantly shorten the periods of acute pain, virus shedding, rash, acute and late-onset anterior segment complications, and, in the case of valacyclovir and famciclovir, the incidence and severity of PHN. However, these medications do not prevent PHN, which remains a common and debilitating complication of HZ in older patients, requiring assiduous pain management. Tricyclic antidepressants, antiseizure drugs, opioids, and topical analgesics all offer some pain relief, and may be combined.. Options are available to manage HZ and reduce the pain of PHN. However, prevention, now possible with the HZ vaccine, is preferable to treatment.

Topics: 2-Aminopurine; Acyclovir; Analgesics; Analgesics, Opioid; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Drug Therapy, Combination; Famciclovir; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Neuralgia, Postherpetic; Valacyclovir; Valine

The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. This report describes SIADH that developed in an elderly woman with single dermatomal herpes varicella zoster ophthalmicus without evidence of varicella zoster encephalitis or dissemination. A 76-year-old woman was admitted to our department for evaluation of left facial pain, confusion and disorientation. Further investigation revealed hyponatremia 112 mEq/L, low serum osmolality, high urine osmolality, normal renal function, normal adrenal and thyroid hormones, and high plasma vasopressin 40 pg/mL. These results indicate that the hyponatremia in this case was due to SIADH and that SIADH was caused by an increased release of vasopressin probably because of the antiviral drug (acyclovir) or infection of varicella zoster virus (VZV) in a single dermatome.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster Ophthalmicus; Humans; Hyponatremia; Inappropriate ADH Syndrome

To review the evidence regarding treatment of herpes zoster (HZ) in the short-term, focusing on the prevention of postherpetic neuralgia (PHN).. The evidence relating to treatment of HZ is derived mainly from randomized controlled trials (level I evidence).. Antiviral drugs might have some effect on the severity of acute pain and on the duration of skin lesions. Corticosteroids also alleviate acute pain. Oral antiviral medication reduces the risk of eye complications in patients with ophthalmic HZ. There is no convincing evidence that antiviral medication reduces the risk of PHN. Some studies, however, have shown that famciclovir and valacyclovir shorten the duration of PHN. The effectiveness of amitriptyline or cutaneous and percutaneous interventions in preventing PHN has not been proven.. Oral antiviral drugs should be prescribed to elderly HZ patients with high risk of PHN. Moreover, these drugs should be prescribed to all patients at the first signs of ophthalmic HZ, irrespective of age or severity of symptoms.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Glucocorticoids; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Neuralgia, Postherpetic; Prednisolone; Time Factors; Valacyclovir; Valine

Presented here is a case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) that developed in an elderly woman with single dermatomal herpes varicella zoster ophthalmicus without evidence of varicella-zoster encephalitis or dissemination. This is only the third such case reported in the English language literature to date, and it affirms that SIADH can develop in patients with herpetic involvement of just a single dermatome and corrects with resolution of the herpetic lesions.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster Ophthalmicus; Humans; Hyponatremia; Inappropriate ADH Syndrome; Sodium; Treatment Outcome

We report a case of zona ophthalmica complicated with a complete ophthalmoplegia. In the literature only 19 cases have been reported the last 30 years, with a variety of possible pathophysiological mechanisms. Our patient's mydriasis reacted to diluted pilocarpine 0.125% which is a sign of Adie's pupil and is not supposed to occur in mydriasis caused by a third nerve palsy. We review the literature on the possible pathogenesis of this hypersensitivity.

Topics: Acyclovir; Aged; Alzheimer Disease; Benzimidazoles; Drug Hypersensitivity; Drug Therapy, Combination; Female; Herpes Zoster Ophthalmicus; Humans; Hyperthyroidism; Injections, Intravenous; Ophthalmoplegia; Ovarian Neoplasms; Pilocarpine

Topics: Acyclovir; Adolescent; Adult; Age Factors; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Diagnosis, Differential; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpes Zoster Oticus; Herpesvirus 3, Human; Herpesvirus Vaccines; Humans; Infant; Infant, Newborn; Male; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Time Factors; Vaccination

Topics: Acyclovir; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Physical Examination; Prognosis; Referral and Consultation; Risk Factors

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

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Antiviral Agents; Chickenpox; Child; Child, Preschool; Diagnosis, Differential; Famciclovir; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpes Zoster Oticus; Humans; Immunocompromised Host; Infant; Infant, Newborn; Male; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Prodrugs; Valacyclovir; Valine

Varicella-zoster infection consists of well-recognized cutaneous manifestations. However, in several cases it is complicated with central nervous system disorders. We present a 79-year-old diabetic woman with zoster ophthalmicus, who developed an acute confusional syndrome. EEG, cranial computed tomographic, biochemical and haematologic and liquoral studies were performed. An increased in the CSF-IgG index was founded, and it was related with Varicella-Zoster Herpes antibodies. She was treated with intravenous acyclovir, and her encephalopathy was resolved.

Topics: Acyclovir; Aged; Antiviral Agents; Encephalitis, Viral; Female; Herpes Zoster Ophthalmicus; Humans; Spinal Puncture; Time Factors

The natural history of herpes zoster ophthalmicus and aspects of its treatment and prevention are presented. Intraocular complications occur in 50 percent of cases. Anterior uveitis and the various varieties of keratitis are commonest, affecting 92% and 52% of patients with ocular involvement, respectively. Sight-threatening complications include neuropathic keratitis, perforation, secondary glaucoma, posterior scleritis/orbital apex syndrome, optic neuritis, and acute retinal necrosis. Twenty-eight percent of initially involved eyes develop long-term ocular disease (6 months), with chronic uveitis, keratitis, and neuropathic ulceration being the commonest. Acute pain occurs in 93% of patients and is still present in 31% at 6 months. Of patients aged 60 and over pain persists in 30% for 6 months or longer, and this rises to 71% in those aged 80 and over. Current evidence favours the use of topical acyclovir alone for treatment of established ocular complications, with topical steroids being withheld in all but the most severe cases. Stellate ganglion block has proved useful in the treatment of established acute pain. Amitryptiline, and to a lesser extent sodium valproate, are useful in established chronic pain. Evidence of the efficacy of early oral acyclovir on ocular complications is conflicting, with two studies reporting significant improvement in differing disease parameters. A similar situation exists for pain, with published studies showing differing effects on pain at varying times after the onset of disease. The use of systemic steroids to prevent pain is not supported by currently available evidence, but its therapeutic relationship with acyclovir requires further evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acyclovir; Aged; Aged, 80 and over; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Pain

To investigate the concentration-side effect relationship in a patient with severe acyclovir-induced neurotoxicity and to summarize the information available in the literature about central nervous system side effects due to acyclovir.. Repeated blood samples were drawn in a patient with severe acyclovir overdose who developed coma and nonoliguric renal failure. The acyclovir levels measured by radioimmunoassay were related to the level of consciousness.. We measured the highest acyclovir serum levels reported so far (229.9 mumol/L = 51.8 mg/L). Impairment of consciousness developed with a remarkable temporal delay of 24 to 48 hours after occurrence of peak serum concentrations and resolved with a comparable delay after reaching the therapeutic range (anticlockwise hysteresis). Six days after discontinuation of the drug, central nervous system symptoms had resolved, and, 4 days later, renal function returned to pretreatment values.. The observation that neurotoxicity developed with a delay of 24 to 48 hours after acyclovir peak serum concentrations could explain the wide range of acyclovir levels reported in similar cases. Single drug level measurements may therefore be of little diagnostic value. Since toxicity develops with a remarkable delay, early removal of the drug (by hemodialysis) could possibly prevent central nervous toxicity.

Topics: Acyclovir; Aged; Brain; Drug Overdose; Electroencephalography; Female; Herpes Zoster Ophthalmicus; Humans; Kidney; Time Factors; Unconsciousness

Topics: Acyclovir; Age Factors; Herpes Zoster Ophthalmicus; Humans; Neuralgia; Recurrence; Virus Activation

Herpes simplex virus type 1 and 2 may cause painful mucocutaneous lesions in both immunosuppressed and immunocompetent patients. Indications for the use of acyclovir (ACV) are reviewed. In the second part the management of infections caused by varicella-zoster virus are discussed. Primary varicella (chickenpox) in immunosuppressed children should be treated with i.v. ACV without delay. In healthy patients varicella pneumonia needs to be treated with ACV. Healthy patients with herpes zoster are not usually candidates for antiviral therapy. The only exception is herpes zoster ophthalmicus. In patients with severe immunosuppression, such as transplant recipients, ACV therapy is recommended in order to reduce the rate of dissemination. First reports and our own observations on the development of ACV-resistant HSV and VZV isolates stress the importance of discriminating use of ACV and other antiviral compounds in immunosuppressed patients.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Child; Herpes Simplex; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Immunocompromised Host

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Acyclovir; Chorioretinitis; Cytomegalovirus Infections; Diagnosis, Differential; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Light Coagulation; Mycoses; Necrosis; Opportunistic Infections; Retina; Retinitis; Syphilis; Toxoplasmosis

Herpes zoster ophthalmicus (HZO) is a unique form of zoster dermatitis associated with a high rate of ocular complications that tend to be chronic and may cause vision loss. The ocular complications are highly varied, with keratitis and uveitis being more persistent sequellae of HZO. Oral acyclovir treatment of acute HZO reduces the incidence of the more common ocular complications, including keratitis and uveitis. Although patients treated early in the course of this disease experience a greater clinical response, treatment as late as seven days after onset of cutaneous lesions confers a beneficial prophylactic effect with respect to the ocular complications of HZO.

Topics: Acyclovir; Clinical Trials as Topic; Herpes Zoster Ophthalmicus; Humans

Herpes zoster ophthalmicus can be complicated by a delayed ipsilateral cerebral angiitis which may cause infarction and a smoldering meningoencephalitis. We describe such a case treated successfully with steroids and acyclovir. It is important to consider the diagnosis of this disorder early since therapeutic intervention may prevent an otherwise high morbidity and mortality. Steroids may have to be continued for some time after clinical resolution, using the ESR as a guideline for decreasing dosages.

Topics: Acyclovir; Aged; Cerebral Infarction; Female; Herpes Zoster Ophthalmicus; Humans; Meningoencephalitis; Prednisone; Vasculitis

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

Herpes zoster is a commonly encountered infectious disease primarily affecting the elderly and immunosuppressed. The natural history and complications of the disease and the principles of management are often not appreciated by clinicians in a variety of disciplines who may see the patient during the acute phase. Recent literature has furthered our understanding of the virology of herpes zoster and the roles of corticosteroid and antiviral therapy. We review the clinical features, diagnostic principles, and management controversies of herpes zoster.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Aged; Antiviral Agents; Child; Diagnosis, Differential; Facial Paralysis; Herpes Simplex; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesviridae; Herpesvirus 3, Human; Humans; Immunity, Cellular; Interferons; Keratitis; Middle Aged; Neuralgia; Uveitis; Vidarabine

Intravenous acyclovir had a significant effect on the resolution of the skin rash in patients with acute zoster, but the 5-day course of therapy was not, in itself, sufficient to treat coexisting ocular involvement. In an open study, topical acyclovir was found to control herpes zoster kerato-uveitis, without recurrences and in a shorter time than if steroids alone were used. The use of steroids in combination with acyclovir led to prolonged treatment and high recurrence rates. A comparative trial of topical acyclovir versus steroids in the treatment of acute herpes zoster kerato-uveitis showed significant differences in favour of acyclovir in terms of the time to resolution of corneal epithelial disease, total treatment duration and the numbers of patients having a recurrence of infection. The reductions in treatment duration and recurrence rate would be expected to result in a reduced incidence of ocular damage and visual loss in acyclovir treated patients.

Topics: Acyclovir; Administration, Topical; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Recurrence; Skin Diseases, Infectious; Steroids

To compare the efficacy and safety of famciclovir with aciclovir for the treatment of ophthalmic zoster.. Randomised, double masked, aciclovir controlled, parallel group in 87 centres worldwide including 454 patients with ophthalmic zoster of trigeminal nerve (V(1)) comprised the intent to treat population. Oral famciclovir 500 mg three times daily or oral aciclovir 800 mg five times daily for 7 days. Assessments included day 0 (screening), days 3 and 7 (during treatment), days 10, 14, 21, 28 and monthly thereafter, up to 6 months (follow up). Proportion of patients who experienced ocular manifestations, severe manifestations and non-severe manifestations; loss of visual acuity was the main outcome measure.. The percentage of patients who experienced one or more ocular manifestations was similar for famciclovir (142/245, 58.0%) and aciclovir (114/196, 58.2%) recipients, with no significant difference between groups (OR 0.99; 95% CI 0.68, 1.45). The percentage of patients who experienced severe and non-severe manifestations was similar between groups, with no significant difference. The prevalence of individual ocular manifestations was comparable between groups. There was no significant difference between groups for visual acuity loss.. Famciclovir 500 mg three times daily was well tolerated and demonstrated efficacy similar to aciclovir 800 mg five times daily.

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Confidence Intervals; Double-Blind Method; Famciclovir; Female; Herpes Zoster Ophthalmicus; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Treatment Outcome; Visual Acuity

To compare the efficacy and safety of valaciclovir and acyclovir in immunocompetent patients with herpes zoster ophthalmicus.. A multicenter, randomized, double-masked study.. One hundred ten immunocompetent patients with herpes zoster ophthalmicus diagnosed within 72 hours of skin eruption were treated; 56 were allocated to the valaciclovir group and 54 to the acyclovir group.. Patients randomized to the valaciclovir group received two 500-mg tablets of valaciclovir three times daily and one tablet of placebo twice daily. Patients in the acyclovir group received one 800-mg tablet of acyclovir five times daily and one tablet of placebo three times daily for 7 days.. Main outcome measures included the frequency, severity, and duration of ocular complications, patient reports of zoster-associated pain, and the outcome of skin lesions. Tolerance was also assessed on the incidence and types of adverse effects and changes in laboratory parameters. The analysis was mainly descriptive and performed on an intent-to-treat basis.. Ocular complications of herpes zoster ophthalmicus were similar in the valaciclovir and acyclovir treatment groups. The main complications were conjunctivitis (54% and 52%, respectively), superficial keratitis (39% and 48%, respectively for punctate keratitis; 11% in each group for dendritic keratitis), stromal keratitis (13% in each group), and uveitis (13% and 17%, respectively). The long-term outcomes of these ocular complications were favorable and similar in both treatment groups. Pain duration and severity and outcome of skin lesions were similar between groups. Most patients reported prodromal pain. After 1 month, 25% of patients in the valaciclovir group and 31% in the acyclovir group still reported pain. The percentage of patients experiencing postherpetic neuralgia decreased during follow-up. The tolerance to acyclovir and valaciclovir was comparable and considered good. The most frequent adverse events were vomiting and edema of the eyelids or face (3%-5%). Three serious adverse events not linked to the study drugs occurred.. Valaciclovir is as effective as acyclovir in preventing ocular complications of herpes zoster ophthalmicus, including conjunctivitis, superficial and stromal keratitis, and pain. Tolerability of the two drugs is similar, but the dosing schedule of valaciclovir is simpler.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Conjunctivitis, Viral; Double-Blind Method; Female; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Keratitis; Male; Middle Aged; Pain; Safety; Tablets; Uveitis; Valacyclovir; Valine

Acyclovir treatment of acute herpes zoster speeds rash healing and decreases pain and ocular complications. The limited oral bioavailability of acyclovir necessitates frequent dosing. Valaciclovir, the l-valyl ester of acyclovir, is rapidly and almost completely converted to acyclovir in vivo and gives three- to fivefold increases in acyclovir bioavailability. In a randomized, double-blind, multicenter study, the safety and efficacy of oral valaciclovir given at a dosage of 1,000 mg three times daily for 7 or 14 days and oral acyclovir given at a dosage of 800 mg five times daily for 7 days were compared in immunocompetent adults aged > or = 50 years with herpes zoster. Patients were evaluated for 6 months. The intent-to-treat analysis (1,141 patients) showed that valaciclovir for 7 or 14 days significantly accelerated the resolution of herpes zoster-associated pain (P = 0.001 and P = 0.03, respectively) compared with acyclovir; median pain durations were 38 and 44 days, respectively, versus 51 days for acyclovir. Treatment with valaciclovir also significantly reduced the duration of postherpetic neuralgia and decreased the proportion of patients with pain persisting for 6 months (19.3 versus 25.7%). However, there were no differences between treatments in pain intensity or quality-of-life measures. Cutaneous manifestations resolved at similar rates in all groups. Adverse events were similar in nature and prevalence among groups, and no clinically important changes occurred in hematology or clinical chemistry parameters. Thus, in the management of immunocompetent patients > or = 50 years of age with localized herpes zoster, valaciclovir given at 1,000 mg three times daily for 7 days accelerates the resolution of pain and offers simpler dosing, while it maintains the favorable safety profile of acyclovir.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Analgesics; Antiviral Agents; Double-Blind Method; Drug Administration Schedule; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Male; Middle Aged; Neuralgia; Pain; Quality of Life; Valacyclovir; Valine

Poor systemic absorption has limited the efficacy of early oral acyclovir in herpes zoster ophthalmicus (HZO). Aqueous humour levels are substantially higher if the drug is administered topically to the eye. A multicentre open randomised study was performed to compare the ocular prophylactic effects of topical and oral acyclovir. Fifty-seven patients with HZO within 72 hours of the onset of rash received either topical acyclovir ointment or 800 mg oral acyclovir, both 5 times daily for 7 days, and were followed for 12 months. Patients receiving ointment were significantly more likely to have ocular complications (p < 0.02) and anterior uveitis was significantly more frequent (p < 0.01) and severe (p < 0.01). Corneal hypoaesthesia was significantly more frequently (p < 0.05) and severe (p < 0.02) at 1 month. From 2 weeks patients receiving ointment were more likely to have pain and at all times their pain was more severe, but these differences were not statistically significant. In spite of its apparently better penetration topical acyclovir appears to have no prophylactic value in the management of early HZO.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Aged; Aged, 80 and over; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis; Male; Middle Aged; Pain Measurement; Scleritis; Treatment Outcome; Uveitis, Anterior

Reports on the natural history of herpes zoster ophthalmicus stress its high morbidity related to vicious scars on eyelids, ocular complications, and post-herpetic neuralgia. Early treatment with oral acyclovir is effective, but the optimal duration of treatment has not been defined.. The authors performed a bicentric, prospective, randomized, double-masked study of 86 patients with acute herpes zoster ophthalmicus, within 72 hours of skin eruption, who received oral acyclovir (800 mg 5 times daily), either for 7 days (plus 7 days oral placebo) or for 14 days. All patients concomitantly received ophthalmic 3% acyclovir ointment; follow-up was at least 6 months.. Statistical analyses of subjective symptoms, skin lesions, and ocular complications showed no significant differences between the groups, suggesting that a 7-day course of treatment was sufficient. Drug tolerance was good. Pooled data from both groups corroborated earlier reports that prompt treatment with oral acyclovir reduces the severity of the skin eruption, the incidence and severity of late ocular manifestations, and the intensity of postherpetic neuralgia. At 6 months, late ocular inflammatory complications were seen in 29.1% of our 86 patients, versus 50% to 71% of untreated patients described by others. Only 13% of our patients experienced post-herpetic neuralgia, which in no case required the use of analgesics.. The authors believe it is not useful to prolong treatment with 800 mg of oral acyclovir 5 times daily for more than 7 days in herpes zoster ophthalmicus. This study confirms the efficacy of oral acyclovir not only against skin lesions and ocular complications, but also against postherpetic neuralgia in herpes zoster ophthalmicus.

Topics: Acyclovir; Administration, Oral; Aged; Double-Blind Method; Drug Tolerance; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Longitudinal Studies; Male; Middle Aged; Placebos; Prospective Studies; Uveitis, Anterior

46 patients with acute herpes zoster ophthalmicus of less than 72 hours duration were recruited into a placebo controlled trial to assess the efficacy of oral acyclovir, 800 mg 5 times daily, in preventing or modifying ocular complications and pain. Fewer acyclovir recipients developed intraocular complications and these were less severe but neither difference was statistically significant. However, active ocular disease was significantly less common in the acyclovir group (p = 0.01) at 6 months. Pain was significantly less severe in the acyclovir group between 2 and 6 months. The proportion of patients with pain scores greater than 0 was significantly lower in the acyclovir group between 2 and 3 months. Oral acyclovir appears to modify the disease process in herpes zoster ophthalmicus, to reduce the severity and incidence of postherpetic pain and especially to protect against long-term ocular complications.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Aged; Aged, 80 and over; Double-Blind Method; Drug Administration Schedule; Eye Diseases; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Pain; Pain Measurement; Placebos; Steroids

Ninety seven new patients with ophthalmic zoster were randomly allocated to three topical treatment groups: acyclovir (ACV) ointment and placebo drops (AP), placebo ointment with steroid drops (PS), and acyclovir ointment with steroid drops (AS). The dosage administered was determined by the score of the ocular inflammation. Follow-up was for at least one year. The results showed that topical ACV alone is insufficient for severe ocular inflammation but is not inclined to lead to recurrences in milder cases. Topical steroid alone is effective but tends to necessitate prolonged treatment. Combined steroid and ACV is questionably better than steroid alone and causes marginally fewer rebound inflammations.

Topics: Acyclovir; Adult; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; Herpes Zoster Ophthalmicus; Humans; Male; Ointments; Ophthalmic Solutions; Recurrence

Herpes zoster ophthalmicus (HZO) is a unique form of zoster dermatitis associated with a high rate of ocular complications that tend to be chronic and may cause vision loss. The ocular complications are highly varied, with keratitis and uveitis being more persistent sequellae of HZO. Oral acyclovir treatment of acute HZO reduces the incidence of the more common ocular complications, including keratitis and uveitis. Although patients treated early in the course of this disease experience a greater clinical response, treatment as late as seven days after onset of cutaneous lesions confers a beneficial prophylactic effect with respect to the ocular complications of HZO.

Topics: Acyclovir; Clinical Trials as Topic; Herpes Zoster Ophthalmicus; Humans

Topics: Acyclovir; Aged; Antiviral Agents; Betamethasone; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged

Herpes stromal disease is due to direct damage as a result of viral replication, virally induced immune mechanisms, or a combination of the two. Viral replication may have a major initiating role in the production of herpes simplex and herpes zoster induced stromal disease, and steroids may initially be harmful in their treatment. On topical antiviral drugs alone, in patients who never previously had had topical steroids, 14 of 15 cases of herpes simplex induced disciform keratitis responded favourably in an average of 44 days of treatment. This compared with one out of 14 responding if steroids had previously been used, 13 of 14 requiring topical steroids and an average 112 days' treatment. In herpes zoster stromal disease cases 78% had epithelial involvement, 54 of 57 responded to topical antivirals alone without the use of steroids, 2% recurred, and treatment averaged a total of 62 days. If steroids were used alone or in combination with antivirals, there was a 50% recurrence rate and 200 day total treatment duration.

Topics: Acyclovir; Administration, Topical; Clinical Trials as Topic; Dexamethasone; Double-Blind Method; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Recurrence; Uveitis; Vidarabine; Virus Replication

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

Seventy-one nonimmunocompromised patients with herpes zoster ophthalmicus, presenting within seven days of onset of characteristic skin eruption, were enrolled in a prospective, longitudinal, randomized, double-masked, placebo-controlled trial with oral acyclovir. In a previous interim report we noted more prompt resolution of dermatomal signs and symptoms with acyclovir treatment. There was also a reduction of viral shedding in acyclovir-treated patients coupled with a trend to greater rate of microdissemination of the virus in placebo-treated patients (Cobo LM, et al. Ophthalmology 1985; 92:1574-83). While further substantiating these findings, we report that a ten-day course of treatment with oral acyclovir (600 mg, five times a day) is well-tolerated and significantly reduces the incidence and severity of the most common complications of herpes zoster ophthalmicus: dendritiform keratopathy, stromal keratitis, and uveitis. While this acyclovir treatment regimen reduces the zoster-related pain during the acute phase of the disease, especially in patients treated within 72 hours of onset of skin lesions, it has no evident effect on either incidence, severity, or duration of post-herpetic neuralgia in the patients studied.

Topics: Acute Disease; Acyclovir; Administration, Oral; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Neuralgia; Pain; Skin

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Random Allocation

A prospective, randomized, double-masked, placebo-controlled clinical trial was conducted to study the effects of oral acyclovir on 55 patients with acute herpes zoster ophthalmicus. Treatment with oral acyclovir resulted in more prompt resolution of signs and symptoms, particularly in patients treated within 72 hours after onset of skin rash (P less than 0.05), and shortened the duration of viral shedding (P = 0.02). Vesicular skin lesions involving other dermatomes (microdissemination) occurred in five (19%) placebo-treated patients but in no acyclovir-treated patients (P = 0.03). Interim analysis of this longitudinal study suggests that the incidence and severity of secondary ocular inflammatory disease was reduced by acyclovir. Prolonged observation of these patients is ongoing to determine if oral acyclovir reduces post-herpes zoster neuralgia or the late ocular complications of ophthalmic zoster.

Topics: Acyclovir; Administration, Oral; Aged; Drug Evaluation; Eye Diseases; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Skin Diseases; Time Factors

Intravenous acyclovir had a significant effect on the resolution of the skin rash in patients with acute zoster, but the 5-day course of therapy was not, in itself, sufficient to treat coexisting ocular involvement. In an open study, topical acyclovir was found to control herpes zoster kerato-uveitis, without recurrences and in a shorter time than if steroids alone were used. The use of steroids in combination with acyclovir led to prolonged treatment and high recurrence rates. A comparative trial of topical acyclovir versus steroids in the treatment of acute herpes zoster kerato-uveitis showed significant differences in favour of acyclovir in terms of the time to resolution of corneal epithelial disease, total treatment duration and the numbers of patients having a recurrence of infection. The reductions in treatment duration and recurrence rate would be expected to result in a reduced incidence of ocular damage and visual loss in acyclovir treated patients.

Topics: Acyclovir; Administration, Topical; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Recurrence; Skin Diseases, Infectious; Steroids

Topical acyclovir has been compared with topical steroids in a coded controlled trial of the treatment of keratouveitis caused by herpes zoster in 40 patients. Topical acyclovir was significantly superior to topical steroids in terms of treatment duration (75 days to 280 days), with no recurrences after the patients were weaned off treatment; there was a 63% recurrence rate in the steroid group. Corneal epithelial disease resolved significantly quicker in the acyclovir treated group. If recurrences occurred in the steroid group, other parts of the eye not initially affected were also involved. Treatment of such recurrences was more difficult than treatment of the initial attack.

Topics: Acyclovir; Administration, Topical; Aged; Betamethasone; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis; Male; Recurrence; Uveitis

The effect of acyclovir on the skin rash and herpes zoster keratouveitis has been studied. It has been shown to have a significant effect on both disease processes, and to be superior to topical steroids in the treatment of herpes zoster keratouveitis. Steroids have been found to have an adverse effect with prolonged treatment and frequent recurrences.

Topics: Acyclovir; Administration, Topical; Betamethasone; Clinical Trials as Topic; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Keratitis; Male; Recurrence; Retrospective Studies; Skin Diseases, Infectious; Uveitis

Topical acyclovir has been found in 15 out of 18 patients to control, without recurrences and in an appreciably shorter time than if steroids were used, keratoconjunctivitis induced by herpes zoster. Once steroids were started, recurrences occurred during withdrawal of steroids or after they had been stopped.

Topics: Acyclovir; Administration, Topical; Adult; Aged; Antiviral Agents; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Zoster Ophthalmicus; Humans; Keratoconjunctivitis; Male; Middle Aged; Steroids

A 56-year-old man presented with right-sided headache and ptosis accompanied by a facial skin rash. He was diagnosed with herpes zoster ophthalmicus (HZO). Despite acyclovir and steroid therapy, the ocular symptoms worsened. Magnetic resonance imaging (MRI) revealed severe orbital inflammation and abnormal lesions in the right trigeminal nucleus and tract. The effects of re-administration of intravenous acyclovir and steroid pulse therapy were limited. Laser irradiation of the stellate ganglion (SGL) and high-dose oral prednisolone therapy were effective. Our experience suggests the efficacy of early multimodal treatment, including SGL, in treating ocular symptoms associated with HZO.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Inflammation; Lasers; Male; Middle Aged; Prednisolone; Stellate Ganglion

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Male; Meningitis

As the understanding of COVID-19 infection becomes better, it is being recognized as a complex multisystem pathology rather than just affecting the lungs. Several ocular findings have been documented by researchers in individuals infected with COVID-19, and ocular symptoms may even be the first presenting feature of COVID-19 infection in 2.26% individuals. Several countries have started vaccination with inactivated or live vaccines to combat this pandemic, and varied side effects have been reported after vaccination. Few cases of herpes zoster have previously been reported in elderly patients with comorbidities after receiving COVID-19 vaccines. In this article, the authors described 2 interesting cases of herpes zoster ophthalmicus (HZO) after receiving a live COVID-19 vaccine. The first case was a 35-year-old immunocompetent man who developed HZO 3 days postvaccine. The second case was a 40-year-old immunocompetent man who developed HZO 28 days postvaccine. To the best of our knowledge, no literature to date has described HZO after live vaccine.

Topics: Acyclovir; Administration, Ophthalmic; Administration, Oral; Adult; Anti-Bacterial Agents; Antiviral Agents; ChAdOx1 nCoV-19; Conjunctivitis, Viral; COVID-19; Drug Therapy, Combination; Herpes Zoster Ophthalmicus; Humans; Male; Moxifloxacin; SARS-CoV-2; Vaccination; Valacyclovir; Visual Acuity

There are several reports that herpes zoster characterized by reactivation of varicella zoster virus (VZV) following coronavirus disease 2019 (COVID-19) vaccines can occur. Herein, we report VZV meningitis, herpes zoster ophthalmicus (HZO), and late neurotrophic keratitis after receiving a second dose of messenger RNA (mRNA) COVID-19 vaccine. A 74-year-old man developed a vesicular skin rash on the forehead, scalp, nose, and left upper eyelid with a severe headache. Five days earlier, he received a second dose of the BNT162b2 mRNA vaccine on his left arm. Ocular examination revealed conjunctival hyperemia and pseudodendrite in the peripheral cornea. VZV was detected in the cerebrospinal fluid using polymerase chain reaction. The patient was diagnosed with HZO and meningitis. The patient was treated with intravenous acyclovir and topical acyclovir ointment and levofloxacin 1.5% eye drops. One month later, he developed a central epithelial defect with a rolled margin, typical of a neurotrophic ulcer. Treatment with a therapeutic contact lens and a combination of topical recombinant human epithelial growth factor and ofloxacin ointment was initiated. At six months after vaccination, the slit-lamp examination findings were stable with a mild corneal superficial stromal haze.

Topics: Acyclovir; Aged; Antiviral Agents; BNT162 Vaccine; COVID-19; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Meningitis; Ointments; Vaccination; Vaccines, Synthetic

To examine risk factors associated with cerebrovascular accident (CVA) following herpes zoster ophthalmicus (HZO).. Retrospective cohort study.. Review of medical records of all patients with HZO seen at the department of Ophthalmology, Auckland District Health Board, New Zealand, between January 1, 2006, and December 31, 2016. The main outcome measure was cerebrovascular accident within 12 months of diagnosis.. A total of 869 patients diagnosed with HZO were included in the study. The median age at onset of HZO was 65.5 years (interquartile range [IQR] 52.9-75.4), and 52.5% (n=456) were male. Antiviral therapy was started in 765 participants (88.0%), not used in 95 (10.9%), and not documented in 9 participants (1.0%). Four hundred sixty-eight participants (54.9%) received prompt oral antiviral therapy (≤72 hours of rash onset). A CVA occurred in the 12 months following HZO in 14 patients (1.6%) and was most common in older patients, occurring in 2.5% aged ≥65 years, 0.7% aged 40-65 years, and 0.9% aged <40 years. Hazard of CVA was highest immediately following HZO, with median time to CVA of 2.3 months (IQR 0.8-5.9 months). Patients who received prompt acyclovir had a 76.2% lower hazard of CVA (0.9% vs 2.6%, P = .022) on multivariate analysis.. Cerebrovascular accident occurs in a low proportion of individuals within 1 year following HZO. Antiviral treatment for HZO may reduce the risk of subsequent CVA when given within 72 hours of rash onset.

Topics: Acyclovir; Aged; Antiviral Agents; Exanthema; Female; Herpes Zoster Ophthalmicus; Humans; Male; Retrospective Studies; Stroke

Topics: Acyclovir; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans

To describe the first case of varicella zoster virus (VZV) retinitis following chimeric antigenic response (CAR) T-cell therapy.. Case review.. A 53-year-old male was treated with CAR T-cell therapy for refractory diffuse large B-cell lymphoma. Nine months after CAR T-cell therapy, he developed VZV skin infection and retinitis. The retinitis responded to systemic acyclovir therapy and intravitreal ganciclovir.. VZV retinitis can occur following CAR T-cell immunotherapy.

Topics: Acyclovir; Cell- and Tissue-Based Therapy; Chickenpox; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Lymphoma, B-Cell; Male; Middle Aged; Retinitis

Herpes Zoster Ophthalmicus (HZO) usually affects the immunocompromised and aged. It results from the reactivation of latent varicella zoster infection in the trigeminal ganglia. Orbital apex syndrome (OAS) is a rare sequela of the disease and tends to be disfiguring and vision-threatening if not addressed. We report on a 43-year-old Ghanaian female living with Human Immunodeficiency Virus infection and on highly active antiretroviral therapy who presented with a 2-month history of a healed vesicular rash left side of the forehead and a droopy left upper eyelid. On examination, she had complete ptosis, visual acuity in the left eye was 6/36, and restricted mobility in all directions of gaze. On anterior segment examination using a slit lamp biomicroscope, the left eye had mild cornea oedema with keratic precipitates and relative afferent pupillary defect (RAPD). Intraocular pressure and posterior segment of the right eye were normal. Computed tomography (CT) Scan of the head was taken to rule out other causes of OAS. Patient was treated with oral acyclovir 400mg five times daily for 30 days, topical steroids and oral prednisolone 60mg daily for 30 days which was tapered. Ptosis improved significantly with mild supraduction and infraduction deficit. Visual acuity improved to 6/12 and all keratic precipitates cleared. The patient, however, developed a corneal scar from a possible neurotrophic ulcer after defaulting treatment for 11 months. OAS , as a rare sequalae of HZO, responds well to oral acyclovir and steroids. Prompt diagnosis and appropriate treatment, even at late presentation, yield positive outcomes.. None declared.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Female; Ghana; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Prednisolone; Syndrome

To investigate differences in outcomes of acute retinal necrosis with confirmed viral polymerase chain reaction between viral types and highlight different treatment options.. The study evaluated 22 eyes in 18 patients of polymerase chain reaction-positive acute retinal necrosis at the University of Pittsburgh Medical Center from 2007 to 2018. Outcome measures included final visual acuity, treatment paradigms, and retinal detachment rate.. Eight eyes were polymerase chain reaction-positive for varicella zoster virus, two eyes for herpes simplex virus Type 1 (HSV-1), and 12 eyes for herpes simplex virus Type 2 (HSV-2). Final Snellen best-corrected visual acuity averaged 20/51 for varicella zoster virus, 20/25 for HSV-1, and 20/814 for HSV-2. Retinal detachment occurred in 2 (25%) of varicella zoster virus eyes and 8 (75%) of HSV-2 eyes. One eye with HSV-1 and three eyes with HSV-2 received cidofovir for treatment of refractory retinitis.. Acute retinal necrosis secondary to HSV-2 tended to have persistent active retinitis with a higher rate of retinal detachment despite similar treatment protocols, suggesting that in some cases combination intravenous acyclovir and adjuvant intravitreal foscarnet injections are not sufficient. Despite the risk of renal toxicity, intravenous cidofovir may be a consideration in select patients.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Female; Follow-Up Studies; Foscarnet; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Visual Acuity

Herpes zoster ophthalmicus usually presents with ocular manifestations, but neurological complications are much more infrequent. An 84-year-old woman with herpes zoster of the left first trigeminal branch developed herpetic keratouveitis in her left eye despite treatment with oral valaciclovir. Seven days later, a progressive and total left ophthalmoplegia appeared, requiring hospital admission and intravenous treatment with acyclovir and corticosteroids. The neuroimaging was suggestive of an orbital apex syndrome. The evolution of the ophthalmoplegia was favourable, with complete resolution at 5 months, but with decreased visual acuity due to the optic nerve involvement.

Topics: Acyclovir; Aged, 80 and over; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Ophthalmoplegia; Valacyclovir

To describe and to compare the clinical manifestation and laboratory test results of herpetic anterior uveitis (HAU) caused by Herpes simplex virus (HSV) and varicella-zoster virus (VZV).. A retrospective, observational study on patients diagnosed with HAU. Etiology, clinical features, ocular complications, and recurrences of the infection were evaluated as main clinical parameters. The aqueous Interleukin-8 (IL-8) level was also measured to assess the intraocular inflammation.. Thirty-two eyes (32 patients) were involved. Among all involved cases, 24 had VZV-AU and 8 had HSV-AU. Common clinical features of HAU included the presence of KPs (90.6%), distorted pupil (83.3%), Iris atrophy (71.9%) and corneal edema (50%). The intraocular fluid analysis showed higher viral load and IL-8 level in VZV-AU.. Compared with HSV-AU, the intraocular inflammation was more severe in VZV-AU. The intraocular fluid analysis was valuable for the etiological diagnosis and the evaluation of disease severity.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Aqueous Humor; Asian People; China; Drug Therapy, Combination; Eye Infections, Viral; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesviridae Infections; Herpesvirus 3, Human; Humans; Interleukin-8; Male; Middle Aged; Referral and Consultation; Retrospective Studies; Simplexvirus; Uveitis, Anterior; Valacyclovir; Viral Load; Visual Acuity; Young Adult

Topics: Acute Kidney Injury; Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Confusion; Diagnosis, Differential; DNA, Viral; Encephalitis; Encephalitis, Varicella Zoster; Exanthema; Hashimoto Disease; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Meningoencephalitis; Neuroimaging; Recurrence

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; Antiviral Agents; Exanthema; Herpes Zoster Ophthalmicus; Humans; Ophthalmoplegia; Orbital Myositis

Topics: Acyclovir; Administration, Cutaneous; Administration, Oral; Adult; Antiviral Agents; Betacoronavirus; Child; Coronavirus Infections; COVID-19; Drug Therapy, Combination; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Ophthalmic Solutions; Pandemics; Pneumonia, Viral; Prednisolone; SARS-CoV-2; Treatment Outcome; Virus Activation

To investigate the clinical characteristics and visual outcome of bilateral acute retinal necrosis.. The study included 30 patients (60 eyes) who were diagnosed with bilateral acute retinal necrosis. The medical records were reviewed.. Twenty-five patients developed the disease in the contralateral eye within 5 months and 5 patients at >2 years after the initial onset. At presentation, 14 of 21 eyes suffered from retinal necrosis of more than 180° in the initially affected eye, whereas 3 of 22 eyes suffered it in the later-affected eye. Retinal detachment occurred in 23 of the 27 initially affected eyes and in 5 of the 27 later-affected eyes. The mean logarithm of the minimum angle of resolution best-corrected visual acuity decreased from 2.0 ± 1.1 (Snellen equivalent counting fingers) to 2.2 ± 1.0 (Snellen equivalent counting fingers) in the initially affected eyes after a follow-up of 34.1 ± 48.2 months (P = 0.529), and improved from 0.5 ± 0.4 (Snellen equivalent 20/66) to 0.3 ± 0.4 (Snellen equivalent 20/40) in the later-affected eyes after a follow-up of 21.2 ± 23.3 months (P = 0.005).. Bilateral acute retinal necrosis usually occurs in the contralateral eye within a few months, but sometimes after several years. Inflammation and retinal necrosis are less severe in the later-affected eye, with less retinal detachment and a better visual outcome.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Eye Infections, Viral; Female; Ganciclovir; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Visual Acuity; Vitrectomy; Young Adult

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Injections, Intravenous; Laser Therapy; Male; Middle Aged; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitrectomy; Young Adult

Topics: Acyclovir; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Ofloxacin; Photography; Staphylococcal Infections

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

Topics: Acyclovir; Administration, Ophthalmic; Anti-Bacterial Agents; Antiviral Agents; Chloramphenicol; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Lubricant Eye Drops; Ophthalmic Solutions; Practice Patterns, Physicians'; Surveys and Questionnaires

Topics: Acyclovir; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Infant; Injections, Intravenous; Male; Photography

To describe a case of posterior scleritis with serous choroidal detachment that occurred as an acute complication of herpes zoster ophthalmicus (HZO).. Retrospective case report.. A 75-year-old female presented with 3 days of painful, decreased vision in her left eye 1 week after being diagnosed with HZO. She had unilateral crusted vesicular lesions in the V1 dermatomal distribution and corneal pseudodendrites. Funduscopic examination demonstrated a large choroidal detachment in her left eye. B-scan ultrasonography revealed unilaterally thickened sclera consistent with posterior scleritis. She was treated with oral prednisone and a 2-week course of intravenous acyclovir. Two weeks after the initiation of treatment, her vision had improved and she demonstrated complete resolution of her pseudodendrites, posterior scleritis, and choroidal detachment.. Prompt recognition and treatment of this unique combination of clinical manifestations of HZO resulted in significant improvement in vision and resolution of the scleritis and choroidal detachment.

Topics: Acyclovir; Aged; Antiviral Agents; Choroid Diseases; Drug Therapy, Combination; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Prednisone; Retrospective Studies; Scleritis; Ultrasonography

A 14-year-old girl developed transient disturbance of consciousness, dysarthria, and clumsiness of the right upper limb 4 months after herpes zoster ophthalmicus. Brain MRI showed acute cerebral infarction in the left middle cerebral artery (MCA) territory. CT angiography demonstrated mild stenosis in the top of the left internal carotid artery and the proximal side of the MCA. Cerebrospinal fluid (CSF) examination showed slightly mononuclear pleocytosis (6/μl). Titer of the anti-varicella zoster virus (VZV) IgG antibodies in CSF was increased, and gadolinium-enhanced brain MRI (T

Topics: Acyclovir; Adolescent; Antibodies, Viral; Antiviral Agents; Biomarkers; Brain; Cerebral Infarction; Drug Therapy, Combination; Female; Fibrinolytic Agents; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunoglobulin G; Magnetic Resonance Imaging; Methylprednisolone; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Valacyclovir; Valine

Herpes zoster ophthalmicus (HZO) has variable initial manifestations, and acute orbital inflammation may be the first sign without apparent zoster rash. This case series is significant for presenting diverse clinical features and treatment options of HZO with acute orbital inflammation.. To report a case series of patients diagnosed as HZO with acute orbital inflammation including two cases with unique presentations.. Medical records of four patients of HZO with acute orbital inflammation were reviewed. Two men and two women with a median age of 57 years (range, 32 to 69 years) were diagnosed as having HZO with acute orbital inflammation. Initial presentations included two cases of zoster rash and two cases of orbital pain preceding vesicles. Clinical orbital findings included proptosis, ptosis, ophthalmoplegia, and decreased visual acuity. Orbital magnetic resonance image showed enlarged extraocular muscle with enhancement and optic nerve sheath enhancement in all four patients, and unilateral dacryoadenitis in one patient. All four patients were administered with systemic steroid, three patients received intravenous acyclovir, and one patient received oral acyclovir. Orbital signs improved in all patients over several months.. Herpes zoster ophthalmicus may initially present with orbital inflammatory signs, such as acute orbital myositis, perioptic neuritis, or dacryoadenitis, without zoster rash. Physicians should be aware of acute orbital inflammation as a presenting sign of HZO.

Topics: Acute Disease; Acyclovir; Adult; Aged; Antiviral Agents; Drug Combinations; Eye Infections, Viral; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Orbital Myositis

A 4-year-old girl presented with acute left visual loss 4 weeks after uneventful chickenpox. She was found to have left necrotising retinitis and profound retinal vasculitis and vitritis. Aqueous humour was PCR positive for varicella-zoster virus. Combined intravenous and intravitreal antiviral treatment led to rapid improvement with settled retinitis, no vascular occlusion and good recovery of vision. Her recent coinfection with Epstein-Barr virus may have acted to provoke the retinitis.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Chickenpox; Child, Preschool; Female; Herpes Zoster Ophthalmicus; Humans; Panuveitis; Retinal Necrosis Syndrome, Acute; Retinal Vasculitis; Treatment Outcome; Vision Disorders

We here report the case of a 9-month infant, born to a mother with a history of varicella in the third trimester of pregnancy but with no history of atopy, admitted to the emergency room with painful, pruritic rash in the right hemiface that had been ongoing for 4 days. During physical examination, the infant appeared to be in pain, with multiple cluster of grouped vesicles on erythematous skin in the right hemiforehead, in the right side of the nose and in the right cheek associated with edema of the upper and lower eyelids, with difficulty opening eyes and purulent conjunctival secretions. The infant was afebrile and in a good general condition. Ophthalmologic examination using the slit-lamp and fundus examination were normal. Complete blood count was normal. The diagnosis of ophthalmic zoster was retained on the basis of the clinical appearance of the lesions. The infant was treated with intravenous Aciclovir for 10 days associated with symptomatic local antiseptic treatment. Patient's evolution was marked by the regression of vesicular lesions and of edema. Viral serologic test and rapid HIV test were negative. The particularity of our study is the occurrence of ophthalmic zoster in an immunocompetent infant, which is rare in children. We made three differential diagnoses which included Kaposi-Juliusberg syndrome, cutaneous infection due to herpes simplex virus and facial erysipelas.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Diagnosis, Differential; Female; Herpes Zoster Ophthalmicus; Humans; Infant; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third

Topics: Acyclovir; Aged; Antiviral Agents; Cranial Nerve Neoplasms; Diagnosis, Differential; Facial Neoplasms; Female; Forehead; Herpes Zoster Ophthalmicus; Humans; Meningioma; Neurilemmoma; Skin Ulcer; Syndrome; Trigeminal Nerve Diseases; Trigeminal Nerve Injuries; Wound Healing

Herpes zoster ophthalmicus (HZO) is an inflammation related to reactivation of the latent varicella zoster virus (VZV), involving the ophthalmic branch of the trigeminal nerve. Optic neuritis (ON), a rare ocular complication following HZO, has been reported in 1.9% of HZO-affected eyes. Most previous cases occurred simultaneously with other ocular complications, especially orbital apex syndrome. Moreover, detailed magnetic resonance imaging (MRI) with diffusion weighted imaging of the optic nerve and trigeminal nucleus in HZO-related ON has been rarely reported. We report a case of postherpetic isolated ON with a concurrent abnormal trigeminal nucleus on imaging.. A healthy 58-year-old female presented with sudden painful visual loss in her right eye for 2 days. Four weeks before the presentation, her right eye was diagnosed with HZO, and she received intravenous acyclovir for 10 days. Ophthalmic examination revealed a visual acuity of light perception and 20/20 in the right and left eyes, respectively. A relative afferent pupillary defect was present in the right eye. Neurological examination was significant for hypoesthesia in the area of the HZO. A clinical diagnosis of HZO-related right retrobulbar ON was made, and other causes of atypical ON were excluded. MRI showed enhancement and restricted diffusion of the right-sided optic nerve with linear hyperintense T2 of the right-sided spinal trigeminal nucleus and tract (STNT) along the brainstem. She received 14 days of intravenous acyclovir and 5 days of methylprednisolone. Both were switched to an oral route for 2 months. After the completion of treatment, the visual acuity was counting fingers and 20/20 in the right eye and left eye, respectively. Stable brainstem STNT abnormalities and resolution of ON were found radiologically.. Isolated ON is a rare ocular complication following HZO. An abnormal high signal of STNT on a T2 weighted image may be present, which may be a clue for VZV-associated complications, such as HZO-related ON, especially in cases lacking an obvious history of HZO or other concomitant ocular complications. Prompt treatment with both acyclovir and corticosteroids should be started. Restricted diffusion of the optic nerve may be a predictor for poor visual recovery.

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Optic Nerve; Optic Neuritis; Trigeminal Nuclei

itor Title: Varicella zoster virus reactivation antedating ipsilateral brainstem stroke Authors: Giuliana Galassi1, Maurilio Genovese2, Marisa Meacci3, Marcella Malagoli2 Affiliations: 1Department of Biomedical, Metabolic, Neural Sciences, University Hospital of Modena, Italy, 2Neuroradiology Service, University Hospital of Modena, Italy, 3Department of Laboratory Medicine and Patholgy, Microbiology and Virology Unit, University Hospital of Modena, Italy Corresponding Author: Giuliana Galassi, MD, Department of Biomedical, Metabolic, Neural Sciences, University Hospital of Modena, Via P. Giardini 1455, Modena, Italy, Tel: 39-3497325802, Email: giulianagalassi46@gmail.com Abstract: Varicella zoster virus (VZV) infection and reactivation are associated with a number of neurologic conditions. Unifocal large vessel infarcts may follow zoster in the trigeminal or cervical distribution as a result of transaxonal transport of virus from trigeminal or cervical afferent fibers that innervate vessels. Ophthalmic zoster (HZO) might cause ophthalmoplegic syndromes, with secondary optic neuritis. Mechanisms include local orbital muscle inflammation and, viral spread from the ophthalmic branch of the fifth nerve with associated vasculopathy. A 72-year-old man developed a vesicular rash in the territory of C5-T5-6. Within four weeks, the patient developed headache, dysphagia, left facial and extremity ataxic weakness. Magnetic resonance imaging (MRI) revealed a right pontine infarction. A 66-year-old woman presented with right-sided painfull HZO. One week later she developed complete external ophthalmoplegia and blurred vision. MRI showed ill-defined signal alteration in the retrobulbar tissue. Three weeks later, the patient was admitted because of dysarthria, deviated tongue, left-sided limb weakness, and tactile hypoesthesia. Spinal fluid contained 23 lymphocytes/mm3 and increased protein. The serum contained antibodies to VZV IgG and IgM in both cases. The patients received intravenously acyclovir with improvement. This report confirms unusual occurrence of ipsilateral brainstem stroke after VZV reactivation in immunocompetent subjects.

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Brain Stem Infarctions; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Pons; Vascular Diseases; Virus Activation

To describe atypical varicella zoster virus (VZV) retinitis in a patient with Good syndrome.. A 63-year-old patient with Good syndrome presented with bilateral necrotizing retinitis starting from the posterior pole. He had a history of thymoma status post thymectomy 4 years previously, left-sided sinusitis, and recent pulmonary aspergillosis. Qualitative PCR was performed on aqueous fluid.. Immunological investigations revealed reduced levels of CD4. Good syndrome should be considered in a patient with opportunistic infections and history of thymoma in the absence of human immunodeficiency virus. Atypical retinitis can occur in patients with Good syndrome and quantitative PCR is important for accurate diagnosis.

Topics: Acyclovir; Agammaglobulinemia; Antiviral Agents; Aqueous Humor; CD4 Lymphocyte Count; DNA, Viral; Eye Infections, Viral; Fluorescein Angiography; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Retinitis; Thymoma; Thymus Neoplasms; Valacyclovir; Valine; Visual Acuity

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 can be associated with a variety of ocular and visual sequelae, including isolated or even multiple cranial neuropathies, potentially affecting the oculomotor, trochlear, or abducens nerves. We report a case of a secondary Brown syndrome following resolution of a unilateral isolated trochlear nerve palsy associated with herpes zoster ophthalmicus in an immunocompetent 57-year-old man.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Ocular Motility Disorders; Strabismus; Trochlear Nerve Diseases

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster Ophthalmicus; Humans; Infant; Polymerase Chain Reaction

Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications. The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated. The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.

Topics: 2-Aminopurine; Acyclovir; Analgesics; Antiviral Agents; Child; Europe; Famciclovir; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Pain Management; Pain Measurement; Pregnancy; Pregnancy Complications; Quality of Life; Societies, Medical

To investigate the prevalence of ocular manifestations and visual outcomes in patients with herpes zoster ophthalmicus (HZO).. Consecutive cases diagnosed with HZO who attended 2 hospitals between July 1, 2011, and June 30, 2015, were retrospectively reviewed. Patient demographics, clinical presentations, and management were reviewed. The logistic regression model was used to estimate the odds ratio of visual loss with ocular manifestations.. A total of 259 patients were included. Of these, 110 (42.5%) patients were <60 years old and 149 patients (57.5%) were ≥60 years old. None of the patients had received zoster vaccination before presentation. Ocular manifestations were present in 170 (65.6%) patients with no difference between both age groups (P = 0.101). Conjunctivitis was the most common ocular manifestation, followed by anterior uveitis and keratitis. After resolution of HZO, 58.7% of patients had a visual acuity of 6/12 or worse. Epithelial keratitis and stromal keratitis were independent risk factors for visual loss after resolution of HZO (P = 0.003 and P = 0.004, respectively). The corresponding odds ratio was 6.59 [95% confidence interval (CI): 1.87-23.19] and 7.55 (95% CI: 1.88-30.30), respectively. The number of ocular manifestations was also associated with an increased risk of visual loss with an odds ratio of 1.49 (95% CI: 1.01-2.20; P = 0.043).. A substantial proportion of patients with HZO were <60 years old in this study. The absence of zoster vaccination across the study cohort was noteworthy. Keratitis was the main reason for poor visual outcome in these patients.

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Conjunctivitis, Viral; Famciclovir; Female; Herpes Zoster Ophthalmicus; Hong Kong; Humans; Keratitis; Male; Middle Aged; Prevalence; Retrospective Studies; Uveitis; Vision Disorders; Visual Acuity; Young Adult

Varicella zoster (VZ) vasculopathy is a rare but well recognized cause of stroke. In the absence of zoster rash and infection in remote past, the disease can pose diagnostic challenge. We report 3 cases of anterior circulation stroke occurring in close temporal relation to VZ. Their clinical, radiologic, and angiographic features are discussed.. Of the 3 patients, 2 had stroke within a span of 4 to 6 weeks of herpes zoster ophthalmicus while the third patient had zoster of cervical dermatome. Magnetic resonance imaging revealed acute subcortical infarcts in 2, while 1 patient showed acute on chronic infarct in left middle cerebral artery territory. The magnetic resonance angiography was abnormal in 2 patients while it was normal in third. All the patients were treated with acyclovir and antiplatelets with good recovery in 2.. VZ associated vasculopathy may have diverse clinical profile and neuroimaging features. It should be considered as an important and treatable cause of stroke in appropriate clinical settings.

Topics: Acyclovir; Antiviral Agents; Brain; Female; Herpes Zoster Ophthalmicus; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Stroke; Treatment Outcome

To report a case of occlusive retinal vasculopathy following varicella zoster infection in an immunocompetent adult.. Observational case report.. A patient with defective vision following chickenpox was evaluated with fluorescein angiography, spectral domain optical coherence tomography and fundus auto fluorescence.. Fundus showed multiple cotton wool spots and a well-demarcated zone of retinal ischemia in the posterior pole with normal optic disc without any evidence of anterior or posterior uveitis. Fluorescein angiography, spectral domain optical coherence tomography and fundus auto fluorescence findings revealed occlusive vasculopathy as the cause of defective vision.. We report a hitherto undescribed case of purely occlusive vasculopathy following varicella zoster infection without features of vasculitis or anterior and posterior uveitis in an immunocompetent individual.

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; Encephalitis, Varicella Zoster; Eye Infections, Viral; Female; Fluorescein Angiography; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Optical Imaging; Prednisolone; Retinal Necrosis Syndrome, Acute; Retinal Vessels; Tomography, Optical Coherence

Topics: Acyclovir; Antiviral Agents; Dacryocystitis; Drug Therapy, Combination; Eye Infections, Viral; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Methylprednisolone; Middle Aged; Orbital Myositis; Polymerase Chain Reaction

Progressive outer retinal necrosis (PORN) associated with varicella zoster virus (VZV) is usually diagnosed in HIV positive or immunosuppressed patients. We report two cases of immunocompetent patients with necrotizing viral retinitis found to have idiopathic CD4 lymphocytopenia.. Clinical presentation, examination, imaging, and laboratory testing of two patients with VZV retinitis are presented.. An HIV negative patient with history of herpes zoster presented with rapid loss of vision and examination consistent with PORN. PCR testing confirmed VZV. Lymphocytopenia was noted with a CD4 count of 25/mm(3). A second HIV negative patient presented with blurred vision and lid swelling and was found to have peripheral VZV retinitis confirmed by PCR. Laboratory workup revealed lymphocytopenia with a CD4 count of 133/mm(3).. VZV necrotizing retinitis classic for PORN can occur in HIV negative patients. Idiopathic CD4 lymphocytopenia should be considered healthy patients who develop ocular infections seen in the immunocompromised.

Topics: Acyclovir; Adult; Antiviral Agents; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Fluorescein Angiography; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; HIV Seronegativity; Humans; Lymphopenia; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Tomography, Optical Coherence; Valacyclovir; Valine; Vitrectomy

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Drug Therapy, Combination; Eye Infections, Viral; Female; Fluorescein Angiography; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Macula Lutea; Middle Aged; Necrosis; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Tomography, Optical Coherence

To study corneal reinnervation and sensation recovery in Herpes zoster ophthalmicus (HZO).. Two patients with HZO were studied over time with serial corneal esthesiometry and laser in vivo confocal microscopy (IVCM). A Boston keratoprosthesis type 1 was implanted, and the explanted corneal tissues were examined by immunofluorescence histochemistry for βIII-tubulin to stain for corneal nerves.. The initial central corneal IVCM performed in each patient showed a complete lack of the subbasal nerve plexus, which was in accordance with severe loss of sensation (0 of 6 cm) measured by esthesiometry. When IVCM was repeated 2 years later before undergoing surgery, case 1 showed a persistent lack of central subbasal nerves and sensation (0 of 6). In contrast, case 2 showed regeneration of the central subbasal nerves (4786 μm/mm) with partial recovery of corneal sensation (2.5 of 6 cm). Immunostaining of the explanted corneal button in case 1 showed no corneal nerves, whereas case 2 showed central and peripheral corneal nerves. Eight months after surgery, IVCM was again repeated in the donor tissue around the Boston keratoprosthesis in both patients to study innervation of the corneal transplant. Case 1 showed no nerves, whereas case 2 showed new nerves growing from the periphery into the corneal graft.. We demonstrate that regaining corneal innervation and corneal function are possible in patients with HZO as shown by corneal sensation, IVCM, and ex vivo immunostaining, indicating zoster neural damage is not always permanent and it may recover over an extended period of time.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Artificial Organs; Cornea; Eye Infections, Viral; Female; Fluorescent Antibody Technique, Indirect; Herpes Zoster Ophthalmicus; Humans; Microscopy, Confocal; Nerve Regeneration; Prosthesis Implantation; Recovery of Function; Sensation; Trigeminal Nerve; Tubulin; Valacyclovir; Valine

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Blepharitis; Eye Infections, Viral; Eyelid Diseases; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Skin Ulcer; Valacyclovir; Valine

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; CD56 Antigen; Exanthema; Eye Infections, Viral; Herpes Zoster Ophthalmicus; Humans; Immunologic Deficiency Syndromes; Killer Cells, Natural; Male

Herpes zoster (HZ) in immunocompetent children is quite uncommon. Initial exposure to the varicella-zoster virus (VZV) may be from a wild-type or vaccine-related strain. Either strain may cause a latent infection and subsequent eruption of HZ. We present a case of HZ in a 15-month-old boy after receiving the varicella vaccination at 12 months of age. A review of the literature regarding the incidence, clinical characteristics, and diagnosis of HZ in children also is provided.

Topics: Acyclovir; Antiviral Agents; Facial Dermatoses; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Infant; Male; Polymerase Chain Reaction

Retrobulbar neuritis in Herpes Zoster Ophthalmicus (HZO) has been reported very rarely.. To report a very rare case of HZO with retrobulbar neuritis with detailed clinical features and treatment responses.. A fifty-eight- year old male presented with Herpes zoster-retrobulbarneuritis in the left eye. It was characterized by decreased visual acuity, mid dilated pupil with sluggish reaction, normal optic disc and central scotoma in Humphrey visual field. Visual acuity improved with systemic Acyclovir and steroids.. This is a rare case of HZO associated with retrobulbar neuritis. Prompt treatment with systemic antiviral and steroid improve the visual outcome.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Optic Neuritis

Several treatments have been described for the management of patients with herpes zoster ophthalmicus (HZO). However, the progress of these patients is usually slow, and many of them develop postherpetic neuritis (PHN). In the present paper, three clinical cases are presented, in which a significant symptomatic improvement was obtained by using a preauricular injection of a mixture of betamethasone depot combined with acyclovir. PHN did not develop in any of them.. The preauricular injection of betamethasone depot and acyclovir could be a good alternative for the management of HZO.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Betamethasone; Delayed-Action Preparations; Drug Therapy, Combination; Ear; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Injections; Male; Middle Aged

To present a case of Herpes Zoster Ophtalmicus (HZO), which was reactivated postoperatively after a sinus lift operation.. A 39-year-old male was referred to our clinic for implant-supported dental rehabilitation. He had maxillary missing teeth in positions 13, 14, 15 and 16 and a pneumatised right maxillary sinus with a bone height of 2 mm. Lateral sinus lifting and bone block grafting was performed before implant insertion. Twelve days after the sinus lift, the patient complained of pain and itching at the infraorbital area extending to the forehead. Clinical examination revealed no signs of infection or allergy. The patient received consultation from a dermatologist in order to rule out a possible dermatological disorder. Finally he was diagnosed with HZO.. HZO was managed with systemic acyclovir treatment. Vesicular rashes and ptosis was seen 3 days after the medical treatment. After 1 month no postoperative skin or orbital sequela was seen. Three implants were inserted at the right posterior maxilla 5 months after sinus lift. One-year followup was uneventful.. Dermatological diseases should always be kept in mind during the differential diagnosis of orofacial pain. In this case the proximity of the operation site and affected area gave rise to the idea that surgical trauma had a possible role in the reactivation of the virus. However, the process of reactivation is not entirely understood and requires further investigations. Early diagnosis is essential for HZO in order to avoid debilitating complications such as postherpetic neuralgia and blindness.

Topics: Acyclovir; Adult; Antiviral Agents; Autografts; Blepharoptosis; Bone Transplantation; Dental Implantation, Endosseous; Exanthema; Follow-Up Studies; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Pain, Postoperative; Pruritus; Sinus Floor Augmentation; Virus Activation

Topics: Acyclovir; Antiviral Agents; Child, Preschool; DNA, Viral; Floxacillin; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Chorioretinitis; Drug Combinations; Exudates and Transudates; Eye Infections, Viral; Fluorescein Angiography; Foscarnet; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Intravitreal Injections; Male; Middle Aged; Ophthalmic Solutions; Parasympatholytics; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Tropanes; Valacyclovir; Valine

The use of in vivo confocal microscopy has been valuable in detecting and managing corneal pathology. This case study documents endotheliitis using in vivo confocal microscopy where apparent resolution of endothelial edema on clinical examination resulted in the discovery of subclinical findings with confocal scanning. The purpose of this case study was to discuss a rare corneal pathology and the clinical value of confocal scanning.. A 30-year-old Asian Indian woman presented with unilateral endotheliitis and trabeculitis of presumed varicella zoster virus etiology. She was treated successfully with oral antiviral and topical corticosteroid therapy. Subclinical endotheliitis was detected using in vivo confocal microscopy, prompting the continuation of prophylactic, low-dose, topical corticosteroid therapy and topical hyperosmotics.. Further research is warranted to better understand the role of confocal microscopy in endotheliitis therapeutic management, endothelial cell count and morphology, and keratic precipitate characterization. To date, prophylactic oral antivirals and/or topical corticosteroids may play a role in immune suppression of the herpes virus, although prospective, randomized, controlled clinical trials have not focused specifically on endotheliitis cases.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Corneal Edema; Drug Therapy, Combination; Endothelium, Corneal; Eye Infections, Viral; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis; Microscopy, Confocal; Prednisolone; Prospective Studies

To report a case of Acute Retinal Necrosis (ARN)-developed nephrotoxicity during intravenous acyclovir treatment and toxic hepatitis during oral valacyclovir treatment.. Interventional case report.. Retrospective chart review.. A 45-year-old male with ARN treated with intravenous acyclovir developed nephrotoxicity. After switching to oral valacyclovir, toxic hepatitis developed. Both renal and liver function tests returned to normal levels after drug cessation. Although rare, clinicians should be aware of the potential nephrotoxic and hepatotoxic side effects of antiviral therapy during ARN treatment.

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Renal Insufficiency; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

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

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

The purpose of this study was to develop a consensus regarding the appropriate regimen to evaluate long-term suppressive antiviral treatment to reduce complications from herpes zoster ophthalmicus (HZO) and identify potential study sites.. In January 2013, a survey of 13 questions was distributed among cornea fellowship directors, board members of the Cornea Society and Ocular Microbiology and Immunology Group, and Kera-net Listserv members. Questions identified respondents' preferred antiviral regimens to administer for chronic or recurrent HZO, gauged the level of interest in participation in a planned randomized clinical trial, and assessed the number of HZO patients treated among specialists in the past year.. Of the 171 respondents who completed the questionnaire, the majority identified as Kera-net Listserv members (107 of 171, 63%) and cornea fellowship directors (46 of 171, 27%). First choice of treatment was valacyclovir 500 mg 2 times per day (61 of 171, 36%), followed by acyclovir 800 mg 2 times per day (56 of 171, 33%), and then valacyclovir 1,000 mg daily (26.9%, 46 of 171). Among the choices, famciclovir consistently placed last among all the respondents (7 of 171, 4%). A majority (106 of 171, 62%) of all respondents, including 70% (26 of 37) of U. S. respondents of the high-volume practices, were interested in participating in a future randomized clinical trial evaluating whether treatment with oral antiviral medications for 1 year decreases complications of HZO.. This survey highlights the strong interest in and support for further study of suppressive antiviral treatment regimens to reduce complications of HZO.

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Attitude of Health Personnel; Chronic Disease; Famciclovir; Female; Health Care Surveys; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Practice Patterns, Physicians'; Surveys and Questionnaires

Topics: Acyclovir; Antiviral Agents; Eyelid Diseases; Female; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Aged, 80 and over; Analgesics; Animals; Comorbidity; Diagnosis, Differential; Drug Therapy, Combination; Erythromycin; Herpes Zoster Ophthalmicus; Humans; Hymenoptera; Insect Bites and Stings; Male; Mupirocin

Topics: Acyclovir; Adolescent; Antiviral Agents; Aqueous Humor; Chorioretinitis; DNA, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Tomography, Optical Coherence; Valacyclovir; Valine; Visual Acuity

Topics: Acyclovir; Antiviral Agents; Child; Herpes Zoster Ophthalmicus; Humans; Male

Topics: Acute Disease; Acyclovir; Antiviral Agents; Child; Female; Fluorescein Angiography; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunocompromised Host; Recurrence; Retinal Vasculitis; Uveitis, Anterior; Virus Activation; Visual Acuity

The objective of this study was to determine current practices and opinions among cornea specialists for treating and preventing recurrences of herpes zoster ophthalmicus (HZO).. In November 2010, a survey of 15 questions was distributed to The Cornea Society listserv. Questions identified respondents' treatment practices for recurrent HZO and opinions regarding prolonged antiviral prophylaxis and zoster vaccine.. Of 100 respondents, the majority were cornea specialists (83 of 98, 85%). Eighty-seven percent (84 of 97) reported treating recurrent or chronic cases of HZO in the last year. The most common choice of treatment in the posed recurrent HZO clinical scenario was a combination of oral antiviral and topical corticosteroid (63 of 100, 63%), although significant variability existed in the duration of oral antiviral administration. Fifty-four respondents (56%) believed that prolonged acyclovir prophylaxis could reduce recurrent signs of HZO; 28% (27 of 98) believed that recurrences of HZO could be reduced after the period of acyclovir administration. For patients with a history of HZO, most respondents reported not recommending the adult zoster vaccine (63 of 98, 64%), but 46% (43 of 94) believed that the vaccine could reduce recurrent signs or did not know.. Many cornea specialists are managing recurrent or chronic cases of HZO, but there is variability in the use of topical corticosteroids and antivirals. Additionally, no consensus exists on the efficacy of prolonged antiviral therapy or the adult zoster vaccine to reduce chronic or recurrent disease. These results demonstrate the need for further systematic study of treatment and prophylaxis for recurrent and chronic HZO.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Antiviral Agents; Attitude of Health Personnel; Chronic Disease; Drug Therapy, Combination; Glucocorticoids; Health Care Surveys; Herpes Zoster Ophthalmicus; Herpes Zoster Vaccine; Humans; Keratitis, Herpetic; Ophthalmology; Practice Guidelines as Topic; Practice Patterns, Physicians'; Recurrence; Surveys and Questionnaires; Treatment Outcome

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; DNA, Viral; Female; Fluorescein Angiography; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Retinal Artery Occlusion; Retinal Necrosis Syndrome, Acute; Retinal Vein Occlusion; Valacyclovir; Valine; Visual Acuity

An 86-year-old female presented with eye pain, complete ophthalmoplegia, a visual acuity of 1/60, vitritis, ptosis, displacement of the eye, and a partially dilated pupil unresponsive to light. A computed tomography of the cerebrum was normal. Herpes zoster ophthalmicus was suspected and treatment with i.v. acyclovir and prednisolone was commenced, which led to a gradual improvement of the clinical condition. Complete ophthalmoplegia due to herpes zoster ophthalmicus is a very rare condition and no evidence-based treatment is available. The prognosis is very good with almost complete remission of the symptoms within 18 months.

Topics: Acyclovir; Aged, 80 and over; Anti-Inflammatory Agents; Antiviral Agents; Aspirin; Eye Diseases; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Ophthalmoplegia; Ophthalmoscopy; Prednisolone; Vitreous Body

Topics: Acyclovir; Adult; Antiviral Agents; Fatal Outcome; Ganciclovir; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunosuppression Therapy; Leukemia, Myeloid, Acute; Male; Polymerase Chain Reaction; Recurrence; Retinal Necrosis Syndrome, Acute; Tomography, Optical Coherence; Vision Disorders; Visual Acuity

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

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Cell Count; Corneal Edema; Drug Therapy, Combination; Endothelium, Corneal; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpes Zoster Vaccine; Humans; Male; Prednisolone; Uveitis, Anterior; Valacyclovir; Valine; Visual Acuity

The authors report a case of internal ophthalmoplegia in a 5-year-old boy presenting after primary varicella infection. This is an uncommon and mostly irreversible ocular manifestation after chickenpox. The internal ophthalmoplegia showed a potential mild improvement with oral acyclovir. Consideration should be given to starting treatment on presentation in such cases.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Chickenpox; Child, Preschool; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Ophthalmoplegia; Visual Acuity

To report a case of progressive outer retinal necrosis (PORN) presenting as a cherry red spot.. Case report.. A 53-year-old woman with recently diagnosed HIV and varicella-zoster virus (VZV) aseptic meningitis developed rapid sequential vision loss in both eyes over 2 months. Her exam showed a "cherry red spot" in both maculae with peripheral atrophy and pigmentary changes, consistent with PORN. Due to her late presentation and the rapid progression of her condition, she quickly developed end-stage vision loss in both eyes.. PORN should be considered within the differential diagnosis of a "cherry red spot." Immune-deficient patients with a history of herpetic infection who present with visual loss warrant prompt ophthalmological evaluation.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; Blindness; Disease Progression; Eye Infections, Viral; Female; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Mucolipidoses; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

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

The following report describes a previously healthy 2-year-old girl with herpes zoster ophthalmicus (HZO). The child presented with a painless vesicular skin eruption covering the left forehead. There was only a history of household exposure to varicella zoster virus (VZV) and the child had not been vaccinated against VZV. PCR assays on vesicular fluid identified VZV DNA. Treatment with acyclovir was started early in the clinical course. In addition, the girl was treated with locally administered ophthalmological acyclovir ointment. Besides some dermal excoriations, a complete resolution of the HZO was achieved without sequelae.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Diagnosis, Differential; DNA, Viral; Facial Dermatoses; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans

Herpes zoster (HZ) is an acute infection caused by reactivation of the latent varicella-zoster virus [1]. Herpes zoster ophthalmicus (HZO) occurs when inflammation spreads from the ganglion of Gasser to the ophthalmic branch of the trigeminal nerve. Optic neuritis, a very rare sequela of HZO [2-4], can occur simultaneously to the acute vesicular skin eruption or, more frequently, as a postherpetic complication. We report on a 74-year-old woman who presented with HZ optic neuritis 45 days after developing an incompletely treated bout of trigeminal HZ, characterized only by pruritus. It is important to value the non-specific manifestations of cutaneous HZ in the prodromal phase, so as to offer timely and appropriate treatment.

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Evoked Potentials, Visual; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Optic Nerve; Optic Neuritis; Visual Acuity

Topics: Acyclovir; Aged; Aged, 80 and over; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Female; Ganciclovir; Herpes Zoster Ophthalmicus; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Vaccination; Valacyclovir; Valine; Visual Acuity

To study the effects of intravitreal foscarnet and the clinical differences between varicella zoster virus (VZV) and herpes simplex virus (HSV) induced acute retinal necrosis (ARN).. Retrospective comparative case series.. Eighty-one eyes of 74 patients.. A retrospective case note analysis was performed in 2 tertiary referral centers.. Presenting and final visual acuity, and progression to retinal detachment.. Thirty-three eyes had HSV-ARN and 48 had VZV-ARN. The average age for HSV-ARN was 34 years and 51 for VZV-ARN (P<0.001). Visual acuity on presentation was similar (P = 0.48), but a larger proportion had better vision (> or =20/60) in the HSV-ARN group (52%) than the VZV-ARN group (35%). A greater proportion of eyes with poor vision (< or =20/200) was found at the 12-month follow-up in the VZV-ARN group (60%) compared with the HSV-ARN group (35%). A greater degree of visual loss in the VZV-ARN group (0.4 logarithm of the minimum angle of resolution [logMAR]) compared with the HSV-ARN group (0.04 logMAR) was detected (P = 0.016). Retinal detachment was 2.5-fold more common in VZV-ARN (62%) compared with HSV-ARN (24%). When comparing eyes treated with (n = 56) and without (n = 25) intravitreal foscarnet, there was a 40% lower rate in retinal detachment (53.6% vs 75.0%) for VZV-ARN (P = 0.23). The numbers with HSV-ARN were too small for analysis.. The results support the difference of outcome in HSV-ARN and VZV-ARN. Therefore, viral identification serves as a key to predicting outcome in these patients. Intravitreal foscarnet seems to be a useful adjunct for the treatment of ARN in that it reduced rate of retinal detachment.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Child; Eye Infections, Viral; Female; Foscarnet; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Male; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Simplexvirus; Visual Acuity; Vitreous Body; Young Adult

Varicella-zoster virus vaccine has diminished the consequences of chicken pox in terms of health and economical burden. The increasing number of doses administered worldwide has revealed rare but important adverse effects that had not occurred during clinical trials. We report here the case of an immunocompetent 3(1/2)-year-old girl who developed encephalitis and herpes zoster opthalmicus 20 months after her immunization with varicella-zoster virus vaccine. Molecular analysis confirmed the vaccine strain as the causative agent. After an intravenous course with acyclovir, the child made a full recovery with no neurologic sequelae.

Topics: Acyclovir; Child, Preschool; Encephalitis, Varicella Zoster; Female; Herpes Zoster Ophthalmicus; Herpes Zoster Vaccine; Humans; Immunocompetence

Here we report a case of optic neuritis in the setting of herpes zoster ophthalmicus (HZO) in a child. A six-year-old girl presented with HZO in the right eye. During the hospitalization, her visual acuity decreased. Fluorescein angiography (FAG) and optical coherence tomography revealed optic neuritis in the affected eye. Visual acuity improved with one month of treatment with acyclovir and steroids. FAG analysis showed no evidence of leakage at the optic disc. At one year post treatment, the patient's fundus exam and vision were normal. Therapy with antivirals and steroids may be effective in patients with childhood HZO optic neuritis.

Topics: Acyclovir; Child; Drug Therapy, Combination; Female; Fluorescein Angiography; Herpes Zoster Ophthalmicus; Humans; Optic Neuritis; Steroids; Visual Acuity

Topics: Acyclovir; Antiviral Agents; Cornea; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis, Herpetic; Microscopy, Confocal; Middle Aged; Ophthalmic Nerve; Prednisolone; Sensory Receptor Cells; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Combined Modality Therapy; Drug Therapy, Combination; Epstein-Barr Virus Infections; Eye Infections, Viral; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Prednisolone; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreous Body

An 80-year-old Caucasian woman had been diagnosed with right herpes zoster ophthalmicus 2 ½ weeks before presentation to our department. Ten days after stopping oral aciclovir, she presented with periorbital pain, visual loss, ptosis and complete ophthalmoplegia. On examination, visual acuity in her right eye was hand movements, with a relative afferent pupillary defect and 2 mm proptosis. MRI demonstrated contrast enhancement within the orbit extending into the apex, suggestive of an inflammatory process. Oral treatment was started with oral aciclovir and corticosteroids for 2 months, when she had resolution of the optic neuropathy and ophthalmoplegia. Vision recovered to 6/9 and repeat neuroimaging revealed regression of the inflammatory process.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster Ophthalmicus; Humans; Ophthalmoplegia

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Child; Female; Herpes Zoster Ophthalmicus; Humans; Ophthalmoplegia; Prednisolone; Treatment Outcome; Ulcer

To report a case of superior orbital fissure syndrome (SOFS) in a patient with herpes zoster ophthalmicus (HZO).. A case report.. A 71-year-old male with HZO presented acutely to accident and emergency complaining of right vision loss, double vision and drowsiness. The right visual acuity was counting fingers. There was no relative afferent pupillary defect. He had interstitial keratitis, ptosis, proptosis and total ophthalmoplaegia. The signs indicated HZO complicated by SOFS. Brain imaging and lumbar puncture confirmed the diagnosis of varicella zoster encephalitis. Systemic acyclovir and prednisolone led to recovery of visual acuity and ocular motility in addition to resolution of his proptosis and ptosis.. SOFS is a rare complication of herpes zoster infection. With the appropriate treatment and follow-up, patients may be reassured that recovery of their visual acuity and ocular motility will occur.

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Dexamethasone; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Orbit; Orbital Diseases; Prednisolone

Topics: Acyclovir; Aged; Antihypertensive Agents; Antiviral Agents; DNA, Viral; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Prednisolone; Retinal Vasculitis; Timolol; Uveitis, Anterior; Vitreous Body

Topics: Acyclovir; AIDS Serodiagnosis; Antiviral Agents; Female; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Ophthalmoplegia; Prednisolone; Ulcer

To determine the viral diagnosis and the outcome of eyes with acute retinal necrosis (ARN) treated with intravenous acyclovir and oral prednisolone alone or combined with early vitrectomy and intravitreal acyclovir lavage.. Nonrandomized, retrospective, interventional, comparative, consecutive series.. A cohort of 27 human immunodeficiency virus-negative patients with ARN comprising 24 unilateral and 3 bilateral cases.. Vitreous biopsy for viral diagnosis. Twenty eyes were treated with intravenous acyclovir in combination with oral prednisolone (group A). Ten eyes were treated additionally with early vitrectomy, intravitreal acyclovir lavage, laser demarcation of necrotic retinal areas when feasible-with or without scleral buckling, and gas or silicone oil tamponade (group B). Vitrectomy was performed in all cases of secondary rhegmatogenous retinal detachment (RD).. Results of vitreous biopsy, rate of RD, rate of phthisis bulbi, and course of best-corrected visual acuity (BCVA).. Varicella zoster virus (VZV) was detected in 26 eyes, followed by herpes simplex virus (5 eyes), and Epstein-Barr virus (2 eyes, in conjunction with VZV). An RD developed in more eyes in group A (18 of 20 eyes) than in group B (4 of 10 eyes; P = 0.007). In 2 of 20 eyes in group A and in 0 of 10 eyes in group B, phthisis bulbi developed without a significant difference between groups A and B. Mean BCVA (logarithm of the minimum angle of resolution) at first visit was 1.09 (standard deviation [SD], 0.83), and mean final BCVA was 1.46 (SD, 0.88) without significant difference between groups A and B.. Varicella zoster virus is the leading cause of ARN. Visual prognosis is guarded. Early vitrectomy with intravitreal acyclovir lavage was associated with a lower incidence of secondary RD; however, it did not improve mean final visual acuity.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Combined Modality Therapy; Drug Therapy, Combination; Epstein-Barr Virus Infections; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prednisolone; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreous Body; Young Adult

To determine clinical features, viral aetiology and treatment outcomes of eyes with acute retinal necrosis (ARN).. Retrospective, interventional, non-comparative case series.. Twenty-two patients (23 eyes) were identified between 1996 and 2007. Varicella zoster virus was the causative agent in 12 patients (nine confirmed by polymerase chain reaction), herpes simplex virus type 1 in six (five polymerase chain reaction-confirmed) and unknown in three patients. Five patients had documented herpes zoster infection in the month prior to the onset of ARN. Twelve patients (55%) had identifiable (clinical or subclinical) immune dysfunction. At 6 months, 3 out of 15 eyes (20%) maintained vision 6/12 or better and 7 (47%) were 6/60 or worse. Median final VA was 6/60. Nine eyes developed retinal detachment and two-thirds of these had received prior barrier laser. Poor prognostic factors for severe visual loss by univariate analysis were male gender (P = 0.019), and the development of retinal detachment (P = 0.05). Delay between onset of symptoms and diagnosis was associated with moderate visual loss (P = 0.018). Barrier laser did not reduce the risk of retinal detachment.. Acute retinal necrosis still has poor visual prognosis. Early diagnosis and initiation of treatment may improve outcome.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Aqueous Humor; Child; DNA, Viral; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Vitreous Body; Young Adult

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Drug Therapy, Combination; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Male; Middle Aged; Polymerase Chain Reaction; Valacyclovir; Valine

To describe the course and complications of varicella zoster ophthalmicus (VZO) in patients attending an eye clinic in a community with a high HIV seroprevalence.. Prospective cohort study of consecutive patients presenting to a tertiary hospital eye clinic with VZO.. Patients recruited in 2001 and 2002 received standardized initial topical and systemic management, which was then modified according to complications. Information on the course and complications of the disease was entered in a database prior to statistical analysis.. Information on 102 patients who had 250 visits to the eye clinic was collected. HIV serology was positive, negative, and unknown in 66, 22, and 14 patients, respectively. The most common complication was uveitis (40/102). Median delay from onset of rash to starting acyclovir was 5 days. Complications were present in 33 patients at the first visit. Complications were commoner in patients with positive Hutchinson's sign and were less common at CD4 counts <200. At CD4 counts, > or =200 HIV infection had little effect on the course and complications of VZO. Timing of commencement of Acyclovir therapy within or after 72 h had no demonstrable effect on the incidence of new complications.. In a resource-limited setting, patients with the following characteristics should have immediate ophthalmic assessment: symptoms suggesting ocular complications or the presence of Hutchinson's sign. All VZO patients should receive antiviral therapy at the first doctor's visit even if they present >72 h after onset of the rash.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Corneal Ulcer; Drug Administration Schedule; Female; Herpes Zoster Ophthalmicus; HIV Seroprevalence; Humans; Male; Middle Aged; Prospective Studies; South Africa; Uveitis

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

Topics: Acyclovir; Adult; Antiviral Agents; Drug Therapy, Combination; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Japan; Male; Middle Aged; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Scleral Buckling; Visual Acuity; Vitrectomy

Complete oculomotor nerve palsy with pupillary involvement is a neuro-ophthalmologic emergency because it is commonly caused by a compressive aneurysm at the junction of the posterior communicating artery and the internal carotid artery. If left untreated, this condition can be potentially fatal within days. The present report describes a 45-year-old African American woman with human immunodeficiency virus who presented with complaint of new-onset nonspecific headache, acute onset of complete oculomotor nerve palsy, and a dilated pupil of the right eye. Results of standard work-up for aneurysm and other etiologic factors were negative. Ten days after presentation, papulovesicular eruptions occurred over the V1 and V2 dermatomes, revealing herpes zoster ophthalmicus. The present case may be the first to identify a patient with complete ophthalmoplegia with pupil involvement as a pre-eruptive manifestation of herpes zoster. The literature on epidemiology, pathogenesis, clinical presentation, diagnosis, and current treatment options for this rare form of shingles are reviewed.

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Ophthalmoplegia; Pupil; Valacyclovir; Valine

Scleromalacia usually appears following vasculitis in systemic rheumatoid diseases, especially as a late symptom of rheumatoid arthritis.. A 67-year-old woman was referred to our hospital for further evaluation with the diagnosis of a "fast-growing tumor" of the left eye. Sixteen months ago she had suffered from herpes zoster ophthalmicus-associated keratouveitis and trabeculitis in the same eye. Scleromalacia associated with varicella-zoster virus (VZV) was diagnosed after the biomicroscopic and gonioscopic examination of the eye was completed and a systemic disease had been ruled out. One week after beginning systemic application of acyclovir (5 x 800 mg daily) and prednisolone (30 mg daily), the anterior chamber inflammation regressed and a fibrosis seemed to appear in the atrophic scleral area.. Although scleral atrophy mostly appears as a late sign of systemic rheumatoid diseases, it might also develop secondary to infectious diseases. Scleromalacia associated with varicella-zoster virus has been previously described only in a few cases. Scleromalacia is a vision-threatening complication of zoster ophthalmicus which responds well to combination therapy with systemic antiviral and anti-inflammatory agents.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Aged; Anti-Inflammatory Agents; Antiviral Agents; Atrophy; Drug Therapy, Combination; Eye Hemorrhage; Female; Fibrosis; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Long-Term Care; Ophthalmoscopy; Prednisolone; Recurrence; Sclera; Scleral Diseases; Uveitis, Anterior

Topics: Acyclovir; Antigens, Viral; Early Diagnosis; Family Practice; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunocompromised Host; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Skin Tests

Acute retinal necrosis (ARN) is a distinct ocular viral syndrome traditionally treated with intravenous acyclovir followed by oral acyclovir. We investigated the use of the oral antiviral medications valacyclovir and famciclovir as the sole treatment for patients with newly diagnosed ARN syndrome.. Retrospective, uncontrolled, interventional case series.. Eight consecutive patients with newly diagnosed ARN treated solely with oral antiviral medications.. All patients received famciclovir or valacyclovir without antecedent intravenous therapy. One patient with bilateral ARN treated with famciclovir received a single intravitreal injection of foscarnet in the more severely involved eye.. Clinically and photographically documented complete resolution of retinitis and best-corrected visual acuity on final follow-up.. Active retinitis resolved completely in 10/10 (100%) affected eyes. Initial response to treatment was seen as early as 4 days (in 5 eyes), with a median time to complete resolution of 14 days. At the last examination, visual acuity was improved (> or = 2 Snellen lines) in 6 (60%) eyes, stable in 2 (20%) eyes, and worse in 2 (20%) eyes. Over a mean follow-up of 36 weeks (range, 7-72 weeks), 3 eyes developed rhegmatogenous retinal detachment that was successfully repaired with 1 vitrectomy surgery. No patient with initially unilateral involvement developed disease in the contralateral eye.. In this pilot study, the use of the oral drugs valacyclovir and famciclovir resulted in complete regression of herpetic necrotizing retinitis. Additional studies are necessary to evaluate the role of these antiherpetic medications in the treatment of the ARN syndrome.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Eye Infections, Viral; Famciclovir; Female; Follow-Up Studies; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Male; Pilot Projects; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Valacyclovir; Valine; Visual Acuity

Motor loss caused by herpes zoster is infrequent, and only a few studies have focused on ocular motor paralysis in ophthalmic herpes zoster. We report a case of complete ophthalmoplegia resulting from ophthalmic herpes zoster. A 69-year-old man presented with complete left-side ptosis with total ophthalmoplegia 7 days after the onset of left ophthalmic herpes zoster. The patient was treated with aciclovir and prednisolone. Five months later, the ptosis had resolved and the extraocular motility had almost returned to normal.

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Male; Ophthalmoplegia; Prednisolone; Treatment Outcome

To determine the viral diagnosis and factors affecting the visual outcome of eyes with acute retinal necrosis.. Nonrandomized, retrospective, interventional, noncomparative series.. A cohort of 22 human immunodeficiency virus-negative patients with acute retinal necrosis (ARN). There were 17 unilateral and 5 bilateral cases.. Diagnostic vitreous biopsy for polymerase chain reaction (PCR) viral DNA analysis, prophylactic barrier laser posterior to necrotic retina to try to prevent rhegmatogenous retinal detachment (RD), intravenous acyclovir in combination with oral, and vitrectomy for RD repair.. Results of PCR viral DNA analysis, relationship between prophylactic barrier argon laser photocoagulation and occurrence of RD, and visual acuities at presentation and follow-up.. Varicella-zoster virus (VZV) was detected in 66.7% (12/18) of eyes (66.7% of patients [10/15]) with vitreous biopsy and herpes simplex virus (HSV) in 22.2% (4/18) of eyes (20% of patients [3/15]). Epstein-Barr virus (EBV) was detected in 16.7% (3/18) of eyes (20% of patients [3/15]), and all the EBV-positive eyes were also positive for VZV. Polymerase chain reaction results were identical in both eyes of bilateral cases (5 patients) and were negative in 11.1% (2/18) of eyes (13.3% of patients [2/15]) biopsied. Systemic corticosteroid treatment given before ARN diagnosis did not appear to increase the risk of developing RD (P = 0.69). Rhegmatogenous RD occurred in 35.3% (6/17) of eyes given prophylactic argon laser treatment and in 80% (8/10) of eyes that could not be lasered prohylactically. Of RDs, 96.3% (13/14) occurred after the third week and up to 5 months from onset of symptoms. The VA after surgical repair of RD improved relative to the presentation acuity in 33.3% (4/12) of eyes.. Varicella-zoster virus is the leading cause of ARN. We recommend the management of ARN to include prompt diagnosis; prophylactic argon laser retinopexy, preferably within the first 2 weeks to reduce risk of RD; systemic acyclovir; and corticosteroids to control the severe inflammation associated with ARN. Despite the guarded visual prognosis, RD repair may result in improved visual outcomes.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Combined Modality Therapy; DNA, Viral; Epstein-Barr Virus Infections; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Herpesvirus 4, Human; Humans; Laser Coagulation; Male; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Vitrectomy; Vitreous Body

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

Topics: Acyclovir; Female; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Trochlear Nerve Diseases

Topics: Acyclovir; Antiviral Agents; Blister; Child, Preschool; Diagnosis, Differential; Female; Herpes Zoster Ophthalmicus; Humans; Risk Factors

Herpes zoster is mainly a disease of the elderly. Its occurrence in younger age should be viewed with suspicion. A 9-year-old boy presented with herpes zoster ophthalmicus. He had a history of abdominal surgery one and half years back during which he had received blood transfusion. A year following the surgery he developed general malaise and fever with progressive weight loss. He was treated by local doctors. Subsequently he developed eruptions of blisters around right eye for a duration of 8 days, with which he presented to the department of ophthalmology, Pt JNM Medical College, Raipur. On investigations he was found to have infected with human immunodeficiency virus. Systemic acyclovir along with antiretroviral treatment was started, to which he showed favourable response.

Topics: Acyclovir; Child; Eye Diseases; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Lamivudine; Male; Nevirapine; Zidovudine

Only a few reports have focused on ocular motor paralysis in herpes zoster ophthalmicus. We report a case of ocular motor paralysis resulting from herpes zoster. The patient, an 80-yr-old woman, presented with grouped vesicles, papules, and crusting in the left temporal area and scalp, with diplopia, impaired gaze, and severe pain. Her cerebrospinal fluid analysis was positive for varicellar zoster virus IgM. Magnetic resonance imaging was performed to rule out other diseases causing diplopia; there were no specific findings other than old infarctions in the pons and basal ganglia. Therefore, she was diagnosed of abducens nerve palsy caused by herpes zoster ophthalmicus. After 5 days of systemic antiviral therapy, the skin lesions improved markedly, and the paralysis was cleared 7 weeks later without extra treatment.

Topics: Abducens Nerve Diseases; Acyclovir; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Skin Diseases, Viral; Treatment Outcome

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

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Antiviral Agents; Eye Infections, Viral; Famciclovir; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine; Visual Acuity

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Aqueous Humor; DNA, Viral; Drug Therapy, Combination; Female; Fluorescein Angiography; Foscarnet; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Macula Lutea; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Tomography, Optical Coherence

To report the cause and magnetic resonance imaging (MRI) findings in a case of abducent palsy following herpes zoster ophthalmicus.. A 76-year-old man presented with acute onset of pain, a vesicular cutaneous eruption and herpes zoster ophthalmicus on the right side. He developed complete abducent palsy on the right side two weeks after onset. MRI with gadolinium enhancement showed Meckel's sinus, which contains the trigeminal ganglion, and the abducent nerve on the right side. The patient was treated with intravenous acyclovir and methylprednisolone. The abnormal enhancement shown on MRI vanished immediately and the ophthalmoplegia resolved significantly.. This is the first reported case where an affected cranial nerve was detected next to the inflammatory cavernous sinus in ophthalmoplegia following herpes zoster ophthalmicus. These MRI findings showed that this ophthlamoplegia was induced by direct viral invasion or extension of inflammation to the ipsilateral cranial nerve. Further studies need to be performed to clarify the role of specific antiviral therapy or anti-inflammatory agents in treating this complication of herpes zoster.

Topics: Abducens Nerve Diseases; Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster Ophthalmicus; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Methylprednisolone; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Chronic Disease; DNA, Viral; Epithelium, Corneal; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Polymerase Chain Reaction; Recurrence

To evaluate the complications of herpes zoster ophthalmicus (HZO) in children.. Prospective-observational case series.. Ten healthy patients (five boys, five girls) with HZO were prospectively followed. Data regarding best-corrected visual acuity, biomicroscopy, intraocular pressure, corneal sensitivity, and funduscopy were collected. The median duration of follow-up was 19 months (range eight to 78 months).. The mean age at presentation was 8.7 years (range two to 14 years +/-3.95). At last visit, two patients (20%) had decreased visual acuity and nine (90%) had some degree of abnormal corneal sensitivity and corneal opacity despite good final visual acuity.. In general, HZO seems to have a good prognosis in healthy children; nonetheless, some cases can present severe eye complications causing visual loss.

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; Child; Child, Preschool; Cornea; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Infusions, Intravenous; Intraocular Pressure; Male; Prognosis; Prospective Studies; Visual Acuity

To explore the possibility of oral antiviral therapy in lieu of intravenous acyclovir for treating acute retinal necrosis (ARN), a necrotizing retinopathy caused by herpes simplex virus type 1 or 2 or by varicella zoster virus.. Retrospective, interventional, small case series.. Four patients (6 eyes).. Patients were treated with oral antiviral therapy. Medications included valacyclovir (1 g 3 times daily), oral famciclovir (500 mg 3 times daily), and topical and oral corticosteroids.. Improvement of symptoms, including photophobia, blurred vision, ocular discomfort, and floaters; increase in visual acuity; and resolution of vitreitis, retinitis, and retinal vasculitis, where present.. Symptoms and visual acuity improved within 2 weeks to 1 month in 3 of 4 patients (75%) treated with oral antiviral medication. One patient required surgical treatment for asymptomatic retinal detachment after 3 weeks of treatment; retinal detachment in the fellow eye was repaired 2 months later. Duration of antiviral therapy ranged from 5 weeks to 3 months.. For 4 patients with relatively indolent cases of ARN, oral antiviral therapy alone was effective in eliminating signs and symptoms of the disease. In particular, oral valacyclovir and famciclovir appeared to be effective, although further study is necessary to determine whether these drugs are as effective as intravenous acyclovir for initial treatment of ARN.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Cytomegalovirus Retinitis; Drug Therapy, Combination; Famciclovir; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Valacyclovir; Valine; Visual Acuity; Vitreous Body

To report a case with necrotizing scleritis due to varicella-zoster infection.. The patient records were evaluated. The present literature was investigated using MEDLINE. A six-year-old boy with varicella infection was admitted to our clinic with redness, pain, and lid edema on the right eye. Slit lamp examination revealed lid edema, purulent secretion, conjunctival injection and chemosis, and inferotemporal scleral necrosis. Sclera was avascular and the conjunctiva was spontaneously detached from sclera in the necrotic region.. Systemic and topical acyclovir treatment was started and a rapid improvement achieved in signs and symptoms.. Ophthalmic manifestations of varicella infection are potentially blinding especially in the absence of appropriate diagnosis and medical intervention. Distinctive skin eruptions are specifically helpful in the early diagnosis of the disease.

Topics: Acyclovir; Antiviral Agents; Child; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Scleritis

To introduce into the clinical nomenclature a sign frequently observed in our patients with persistent corneal inflammation associated with herpetic stromal keratitis.. Case reports and review of the literature.. Four representative patients with herpesvirus stromal keratitis are presented. Herpes simplex virus-1 (HSV-1) was confirmed by culture in 1 case and by polymerase chain reaction in a second case. In the remaining 2 cases, the diagnosis was made based on characteristic clinical findings for herpes simplex virus and varicella zoster virus (VZV). On clinical examination, all 4 representative cases of stromal keratitis revealed a well-defined, localized region of intertwined, metallic-like, polychromatic material in the corneal stroma, a sign we have termed steel wool keratopathy. We have only rarely observed this finding in patients with stromal keratitis not caused by a herpesvirus.. Steel wool keratopathy seems to represent a focal region of stromal degeneration or deposition associated with chronic inflammation. Although we most often observe this finding in patients with stromal keratitis secondary to HSV or VZV, we cannot exclude the possibility that this sign represents the sequelae of chronic/recurrent inflammation rather than a specific pathologic response to herpetic antigens.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Chronic Disease; Corneal Stroma; DNA, Viral; Female; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Middle Aged; Polymerase Chain Reaction

Topics: Acyclovir; Anti-Bacterial Agents; Blood Chemical Analysis; Child, Preschool; Drug Therapy, Combination; Encephalitis, Varicella Zoster; Enzyme-Linked Immunosorbent Assay; Follow-Up Studies; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome

To report a case of chronic recurrent varicella virus epithelial keratitis in a child.. Case report.. Clinical examination and polymerase chain reaction analysis of corneal epithelium.. A 10-year-old healthy child developed chronic recurrent varicella virus keratitis with pseudodendrites after recovering from systemic varicella. Analysis of the debrided pseudodendrites was repeatedly positive for VZV DNA and negative for HSV DNA. Treatment with oral acyclovir and topical corticosteroid drops was effective in eliminating the pseudodendrites; however, recurrences occurred once the medications were discontinued.. Varicella virus epithelial keratitis in children can be a recurrent chronic condition requiring prolonged treatment.

Topics: Acyclovir; Antiviral Agents; Child; Chronic Disease; DNA, Viral; Epithelium, Corneal; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Polymerase Chain Reaction; Recurrence

We report a case of a 73-year-old patient with complete ophthalmoplegia following an episode of ophthalmic herpes zoster. MRI showed an associated ipsilateral temporal meningioma with cavernous sinus extension. We discuss the possible responsibility of these two conditions in the ocular motor signs.

Topics: Acyclovir; Aged; Anisocoria; Anti-Inflammatory Agents; Antiviral Agents; Blepharoptosis; Brain Neoplasms; Female; Herpes Zoster Ophthalmicus; Humans; Magnetic Resonance Imaging; Meningioma; Methylprednisolone; Ophthalmoplegia; Temporal Lobe; Valacyclovir; Valine; Visual Acuity

To study the incidence of herpetic eye disease (HED) of the ocular surface in diabetics.. Observational historical cohort study.. A district of the largest health maintenance organization in Israel (the Central District of Clalit Health Services).. We reviewed the electronic medical records of all patients older than 50 years (159634 patients) in the district, and of these, 22382 (14.0%) patients had diabetes mellitus.. All filled prescriptions for acyclovir eye ointment between January 1, 2001 and December 31, 2003 (1483 tubes) and all hemoglobin A1c laboratory tests during 2003 (41910 tests) were documented. An ocular surface HED event was defined when a patient consumed at least 1 tube of topical acyclovir per month, whereas no acyclovir use was documented 3 months before and 3 months after that event.. Incidence of ocular surface HED events in diabetics compared with nondiabetics adjusted for age and gender.. After age and gender adjustment, significantly more diabetics had ocular surface HED (5.21 per thousand) compared with nondiabetics (4.27 per thousand; P<0.0001). Stratification by age revealed a significantly higher prevalence of HED in diabetics, aged 60 to 79 years. Recurrent herpetic events occurred during the study period in 25.2% of HED-affected diabetics, and in 16.6% of HED-affected nondiabetics (P = 0.05). Diabetics with poor glycemic control (mean annual hemoglobin A1c > 9%) consumed significantly more ocular acyclovir (P = 0.01). Multivariate analysis revealed this effect to be independent of age, gender, place of birth, or place of residency.. Ocular surface HED is significantly more common among patients with diabetes mellitus. Poor glycemic control correlates with increased consumption of ocular acyclovir in diabetic patients.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Diabetes Mellitus; Drug Prescriptions; Drug Utilization; Female; Health Maintenance Organizations; Herpes Zoster Ophthalmicus; Humans; Incidence; Israel; Keratitis, Herpetic; Male; Middle Aged; Prevalence; Registries

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; DNA, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Lasers; Male; Ophthalmoscopy; Polymerase Chain Reaction; Retina; Retinal Necrosis Syndrome, Acute; Vitreous Body

A 74-year-old woman was referred to the authors' clinic with a 1-week suspicion of giant-cell arteritis. Uncomplicated, bilateral temporal artery biopsies were performed 3 days after admission for therapy. Four hours after the procedure she developed vesicular lesions of the face compatible with herpes zoster ophthalmicus. The temporal artery biopsy revealed perineural lymphocytic aggregation. Both giant-cell arteritis and herpes zoster ophthalmicus form part of the differential diagnosis in elderly patients with headache. In such cases, clues from a temporal artery biopsy may aid in diagnosis of herpes zoster. In addition, the patient in this case developed the rash 10 days after onset of symptoms, which is rare as the average time from onset of symptoms to rash in zoster is 3-5 days.

Topics: Acyclovir; Aged; Antiviral Agents; Biopsy; Diagnosis, Differential; Female; Giant Cell Arteritis; Herpes Zoster Ophthalmicus; Humans; Ophthalmic Nerve; Temporal Arteries; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Combined Modality Therapy; Cranial Irradiation; False Negative Reactions; Hematopoietic Stem Cell Transplantation; Herpes Zoster Ophthalmicus; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Leukemia, Myeloid; Leukemic Infiltration; Male; Mesencephalon; Methotrexate; Oculomotor Nerve Diseases; Recurrence; Transplantation, Homologous; Virus Activation

To evaluate the clinical outcome and medical management in a series of patients diagnosed with acute retinal necrosis.. Between 1993 and 2000, 22 patients suffering from acute retinal necrosis were referred to our department. We retrospectively reviewed the clinical course, delay between diagnosis and first clinical manifestation, biological profiles, treatment and complications.. All patients had vitreous inflammation; retinitis was seen upon examination in 82% of the cases. Nevertheless, for six patients (27% of the cases), failure to recognize the diagnosis led to delay (mean, 5.5 days) between the first ophthalmological examination and antiviral therapy. Nineteen patients underwent laboratory evaluation, and virological diagnosis was made in 16 of them: varicella zoster virus was found in 11 cases, herpes simplex type 1 in three cases, and herpes simplex type 2 and cytomegalovirus in one case each. Nine patients were treated with a combination of aciclovir and foscarnet and 13 with aciclovir alone. Among the 16 patients who received aciclovir, one did not respond to therapy after 2 days and was cured only after foscarnet was added. Recurrence occurred at the end of treatment in only one patient. Retinal detachment complicated the course for 11 patients and was always associated with proliferative vitreoretinopathy. Among those, seven of the ten patients who accepted surgery were successfully treated. Eleven out of 22 patients had a final visual acuity up to 20/200 and two up to 20/40.. In our series, acyclovir alone was sufficient to cure the majority of cases. Even with antiviral therapy, the prognosis of acute retinal necrosis remains poor. Retinal detachment is the main complication.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Cytomegalovirus Retinitis; Drug Therapy, Combination; Eye Infections, Viral; Female; Foscarnet; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Infant; Male; Middle Aged; Prognosis; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Visual Acuity; Vitreoretinopathy, Proliferative

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Drug Therapy, Combination; Famciclovir; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Male; Middle Aged; Trifluridine

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cidofovir; Cytosine; Drug Resistance, Viral; Fatal Outcome; Female; Foscarnet; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Organophosphonates

External ocular muscle palsies in patients with ophthalmic zoster are traditionally interpreted as diseases of III, IV or VI cranial nerves. Orbital myositis associated with zoster ophthalmicus has been diagnosed only rarely. We describe a patient with ophthalmic zoster and external ophthalmoplegia due to ocular myositis demonstrated by MR imaging. Treatment with acyclovir and cortisone resulted in a rapid improvement of the ophthalmoplegia. In ophthalmic herpes zoster associated with external ocular muscle palsies, ocular myositis is an important differential diagnosis to inflammatory involvement of the cranial nerves III, IV, and VI.

Topics: Acyclovir; Aged; Antiviral Agents; Brain Stem; Cortisone; Female; Gadolinium; Herpes Zoster Ophthalmicus; Humans; Magnetic Resonance Imaging; Myositis; Ophthalmoplegia

This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; Cataract; Disease Progression; Drug Therapy, Combination; Fluorescein Angiography; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Male; Phacoemulsification; Retinal Necrosis Syndrome, Acute; Visual Acuity

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Age Factors; Aged; Antiviral Agents; Famciclovir; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Ointments; Time Factors; Trigeminal Ganglion; Trigeminal Nerve; Valacyclovir; Valine

To report a case of herpes zoster virus sclerokeratitis with anterior uveitis following vaccination with live attenuated varicella vaccine (Oka strain).. Case report.. The case records of the patient were reviewed retrospectively. Pertinent literature citations were identified using MEDLINE.. A 9-year-old boy presented with herpes zoster ophthalmicus 3 years following vaccination with live attenuated varicella vaccine (Oka strain). Examination of the affected eye revealed a moderate follicular response on the palpebral conjunctiva, decreased corneal sensation, mildly elevated intraocular pressure, diffuse anterior scleritis with marginal keratitis, and a moderately severe anterior uveitis. Amplified DNA from fluid taken from the base of a cutaneous vesicle produced wild-type varicella zoster virus (VZV) DNA, not Oka strain.. Herpes zoster virus infection needs to be considered in all patients who present with scleritis, keratitis, or anterior uveitis, regardless of their varicella vaccination status.

Topics: Acyclovir; Antiviral Agents; Chickenpox Vaccine; Child; Cyclopentolate; DNA, Viral; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis; Male; Prednisolone; Scleritis; Trigeminal Nerve Diseases; Uveitis, Anterior; Vaccination

To determine the prognostic value of nasociliary skin lesions (Hutchinson's sign) for ocular inflammation and corneal sensory denervation in acute herpes zoster ophthalmicus.. A longitudinal observational study with a 2-month follow-up was performed involving 83 non-immunocompromised adults with acute herpes zoster ophthalmicus, with a skin rash duration of less than 7 days, referred by their general practitioner. All skin lesions at the tip, the side and the root of the nose, representing the dermatomes of the external nasal and infratrochlear branches of the nasociliary nerve, were documented by taking photographs and marking anatomical drawings. Ocular inflammatory signs were observed by slit-lamp biomicroscopy, and corneal sensitivity was measured with the Cochet-Bonnet esthesiometer at 2-month follow-up.. Hutchinson's sign was a powerful predictor of ocular inflammation and corneal denervation in herpes zoster ophthalmicus [relative risks: 3.35 (CI 95%: 1.82-6.15) and 4.02 (CI 95%:1.55-10.42), respectively]. The manifestation of herpes zoster skin lesions at the dermatomes of both nasociliary branches was invariably associated with the development of ocular inflammation.. Clinicians should be alert for early skin lesions within the complete nasociliary dermatome, because they are a reliable prognostic sign of sight-threatening ocular complications in acute herpes zoster ophthalmicus.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Cornea; Cranial Nerve Diseases; Female; Herpes Zoster Ophthalmicus; Humans; Hypesthesia; Male; Neuralgia; Neurons, Afferent; Ophthalmic Nerve; Prognosis; Skin; Skin Diseases, Viral

To report two cases of progressive outer retinal necrosis occurring in immunocompetent individuals after treatment with corticosteroids for presumed optic neuropathy.. Observational case report.. University-based tertiary eye hospital.. Retrospective review of existing clinical records.. Two patients were treated empirically with systemic corticosteroids for suspected inflammatory papillopathy. Subsequently, both were diagnosed with necrotizing herpetic retinitis with features of progressive outer retinal necrosis. Anterior chamber paracentesis confirmed varicella-zoster infection. Both patients were human immunodeficiency virus negative; one patient with rheumatoid arthritis was taking etanercept. Both became completely blind in one eye despite intensive treatment with antiviral medication intravenously and intravitreally.. Progressive outer retinal necrosis is not confined to patients with underlying severe immunodeficiency, such as acquired immune deficiency syndrome. Initial treatment of acute, unexplained vision loss with systemic corticosteroids may lead to catastrophic visual loss in patients with evolving necrotizing herpetic retinopathy.

Topics: Acyclovir; Aged; Antiviral Agents; Aqueous Humor; Blindness; DNA, Viral; Drug Therapy, Combination; Female; Foscarnet; Ganciclovir; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunocompromised Host; Middle Aged; Multiple Sclerosis; Optic Neuritis; Polymerase Chain Reaction; Prednisone; Pupil Disorders; Retinal Necrosis Syndrome, Acute; Retrospective Studies

The author report about study results conducted in Russia during the recent 30 years and dedicated to the treatment of ocular pathologies caused by the virus of herpes simplex. Three high-efficiency directions took shape during the mentioned period: 1. Non-specific antiviral therapy based on the local and systemic administration of interferon inductors (poludan--complexes of poly A, poly U etc.) possessing an extensive spectrum of the antiviral and immune-modeling actions; 2. Antirecurrent therapy, including the application of herpetic vaccine against the virus of herpes simplex, types I and II, combined with immune-modeling agents. A focal allergic test with herpetic vaccine was offered, it made it possible, for the first time, a non-invasive diagnostics of intraocular herpes. 3. A system of sparing microsurgical methods adapted to the treatment of an active herpetic keratitis and its outcomes. A synergistic effect of interferon inductors and acyclovir was proven both experimentally and clinically; a method of local autocytokinotherapy (based on poludan), which turned out to be most effective in the treatment of severe lesions at the cornea and of intraocular herpes, was worked out. The authors believe that the methods and means offered for the treatment of ophthalmoherpes contribute, to a great extent, to handling with the ocular herpes viral infection.

Topics: Acyclovir; Adult; Antiviral Agents; Eye; Herpes Zoster Ophthalmicus; Herpesvirus Vaccines; Humans; Injections, Subcutaneous; Male; Middle Aged; Ointments; Ophthalmic Solutions; Polyribonucleotides

To determine the normal spectrum of ocular complications and associated visual outcome in patients with herpes zoster ophthalmicus.. This prospective observational cohort study included 73 immunocompetent adults with herpes zoster ophthalmicus, referred by their general practitioners within 7 days of skin rash onset. The follow-up period was 6 months. All patients received a 7-14-day course of systemic aciclovir treatment combined with longterm application of a lubricating ophthalmic ointment as long as the corneal epithelium was affected. Topical corticosteroids were strictly avoided in the acute phase of ocular disease. Acquired visual loss scores at 1, 2 and 6 months were based on best corrected visual acuity (BCVA) level and evaluation of the ophthalmological history and findings.. Ophthalmic herpes zoster led to a variety of transient inflammatory reactions within the anterior eye segment of the involved side in 46 patients (63%), but did not seriously compromise their ultimate visual outcome. Mild to moderate visual loss, with corrected VA between 0.3 and 0.8, was found in 17 patients at 1 month (23%), in 10 patients at 2 months (14%) and in seven patients at 6 months follow-up (10%). None of the patients developed visual loss with a corrected VA of less than 0.3.. Functional vision was retained in all ophthalmic zoster patients referred to the ophthalmologist in the acute phase of the disease by vigorous antiviral treatment and adequate prevention of corneal exposure.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Male; Middle Aged; Prognosis; Prospective Studies; Visual Acuity

To report a side effect of epidural corticosteroid injections for back pain.. Case series.. Review of clinical charts and photographs.. Private retina practice.. Two patients developed acute retinal necrosis syndrome following epidural corticosteroid injections for back pain. Referral was delayed in one patient. One patient developed bilateral secondary rhegmatogenous retinal detachment, and both developed secondary macular pucker.. Acute retinal necrosis can follow epidural corticosteroid injections. Patients should be warned about this possibility and advised to report should photopsias, photosensitivity, blurred vision, or new floaters develop after treatment. Orthopedists should be aware of the complication and promptly refer patients with symptoms for dilated fundus examination by an ophthalmologist.

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Immunoglobulin G; Injections, Epidural; Low Back Pain; Male; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Virus Activation

Interferon gamma (IFN-gamma) has been reported to play an important role during virus infections. The purpose of this study was to examine the relationship between IFN-gamma expression and the clinical course of patients with acute retinal necrosis syndrome (ARN) associated with the varicella-zoster virus (VZV).. Six patients with ARN were studied. The aqueous and/or vitreous were examined by reverse transcriptase-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay during the follow-up period. The presence of VZV genome was also determined by PCR. The results were correlated with the clinical data and features and compared with patients with other ocular diseases.. A statistically significant higher level of IFN-gamma was detected in the aqueous and/or vitreous in eyes with ARN than in eyes with other ocular diseases. A statistically significant positive correlation was observed between the level of IFN-gamma in the vitreous and the final visual acuity. IFN-gamma was reduced to undetectable levels within 30 days after the initial eye symptoms. Three of five patients had severe inflammation initially, and the visual acuity gradually recovered with the disappearance of VZV and higher levels of IFN-gamma. Conversely, the other 2 patients showed mild inflammation, had a slow decrease of visual acuity with persistent VZV, and lower levels of IFN-gamma expression.. Our results suggest that IFN-gamma may be one of the factors that plays an important role in the clinical course of VZV-associated ARN.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Combined Modality Therapy; Dexamethasone; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Genome, Viral; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Interferon-gamma; Retinal Necrosis Syndrome, Acute; Reverse Transcriptase Polymerase Chain Reaction; Visual Acuity; Vitrectomy; Vitreous Body

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

To report the use of intravenous (IV) antiviral agents and intravitreal ganciclovir injections in three immunocompetent patients with severe acute retinal necrosis (ARN).. Case series.. Three immunocompetent patients, who had lost vision in the first eye due to ARN, received intensive treatment with IV foscarnet or acyclovir or ganciclovir and intravitreal ganciclovir injections for the treatment of severe ARN involving the fellow eye. The retinitis resolved and final visual acuity of the fellow eye improved to 20/20 in all three cases after a mean follow-up of 17 months.. Intensive treatment with a combination of two intravenous antiviral drugs and intravitreal ganciclovir injections was successful in the management of patients with acyclovir-resistant ARN and monocular status.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Drug Therapy, Combination; Female; Foscarnet; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Injections; Male; Necrosis; Retinitis; Severity of Illness Index; Visual Acuity; Vitreous Body

Two cases of acute retinal necrosis (ARN-) syndrome caused by an infection with varicella zoster virus (VZV) are demonstrated. VZV-DNA was detected in vitreous biopsies by polymerase-chain-reaction (PCR). The course of retinal necrosis was decisively improved by changing antiviral therapy from aciclovir and/or ganciclovir to brivudine.. Patient 1: 51 years, male, initial visual acuity 20/40; patient 2: 17 years, female, initial visual acuity 20/30. Both patients were immunocompetent and presented with an unilateral acute retinal necrosis syndrome with peripheral chorioretinitis, retinal vasculitis, vitreous inflammation and optic disc swelling, which resulted in progressive visual loss in a few days.. In both patients VZV-DNA was detected in vitreous biopsies with PCR. A regression of intraocular inflammation and necrotic retinal foci was only observed after changing the initial systemic therapy from aciclovir (Zovirax) intravenously 1500 mg/day) and/or ganciclovir (Cymeven) intravenously 250 mg/day) to brivudine (Zostex) per os 500 mg/day). Vitreoretinal surgery was necessary in both patients because of rhegmatogenous retinal detachment. Visual acuity stabilised in patient 1 to 20/200 and in patient 2 to 20/25 during a follow-up of 16 or 32 months, respectively.. Brivudine represents an alternative therapy, if standard treatment with aciclovir and/or ganciclovir failed in cases of ARN-syndrome due to presumed drug-resistant varicella zoster virus-subtypes. Complete remission and preservation of a satisfactory function can be achieved.

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; Bromodeoxyuridine; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Recurrence; Retinal Necrosis Syndrome, Acute; Retreatment; Treatment Failure

Nephrotoxicity is a well-known side effect of intravenous acyclovir treatment but occurs rarely by oral treatment. A 76-y-old healthy male, with normal baseline renal functions (blood creatinine 0.6 mg%), received oral acyclovir at a dose of 800 mg five times daily for 10 days for treatment of herpes zoster ophthalmicus. He developed renal failure with blood creatinine levels of 3 mg% and his renal function failed to improve within eight months of end of treatment. Affection of renal function has to be considered also in relation to oral acyclovir treatment, especially in elderly subjects.

Topics: Acyclovir; Administration, Oral; Aged; Antiviral Agents; Creatinine; Herpes Zoster Ophthalmicus; Humans; Kidney Failure, Chronic; Male

To compare clinical characteristics and outcomes in patients with uveitis caused by herpes simplex virus (HSV) and varicella zoster virus (VZV).. Retrospective comparative study.. Forty patients with HSV uveitis and 24 patients with VZV uveitis.. A retrospective study of 40 patients with HSV and 24 patients with VZV uveitis was performed. The patients were followed between May 1987 and September 1999 (median follow-up time, 46 months). The diagnosis of HSV uveitis was made clinically and serologically, and the diagnosis of VZV uveitis was made clinically.. Clinical presentation of the disease, ocular complications, visual acuity, surgical and medical treatments needed.. Both populations were comparable for gender and age at disease onset. The course of the disease tended to be remitting and recurrent in HSV patients and chronic in VZV patients (P = 0.046). The most frequent ocular complication in both groups was secondary glaucoma (54% HSV, 38% VZV). Twenty-five percent of VZV patients developed posterior pole complications (cystoid macular edema, epiretinal membrane, papillitis, retinal fibrosis, and detachment) compared with 8% of HSV patients (P = 0.069). Treatment modalities selected were generally similar in the two groups, although periocular and systemic steroids were required more frequently in HSV patients (60% versus 25%; P = 0.01). Surgical procedures were required with similar frequency in both populations. The percentage of eyes that were legally blind at end of follow-up was also comparable (HSV, 20%; VZV, 21%). The visual outcome was similar in the studied populations.. This study represents the only direct comparison of HSV and VZV uveitis patients reported in the literature. HSV patients were more likely to be treated with periocular and systemic steroids, and VZV patients were more likely to develop posterior pole complications (a finding of borderline significance). Other parameters evaluated in this study were not statistically different in the two patient groups.

Topics: Acyclovir; Antiviral Agents; Cataract; Female; Glaucoma; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesviridae Infections; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Recurrence; Retinal Diseases; Retrospective Studies; Uveitis; Visual Acuity

Topics: Acyclovir; Aged; Antiviral Agents; Giant Cells; Herpes Zoster Ophthalmicus; Humans; Male

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Child, Preschool; DNA, Viral; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Fluorescein Angiography; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Visual Acuity

Topics: Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Eye Infections, Viral; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Male; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Two cases of Herpes zoster ophthalmicus complicated by motor nerve palsies are being reported. The investigations ruled out other diseases which can affect ocular motor nerves, e.g., diabetes, hypertension, syphilis and malignancy. The cases are being reported because of the rare presentations of Herpes zoster ophthalmicus like isolated internal ophthalmoplegia and VI nerve palsy in Case-1 and absence of iritis with third nerve involvement in Case-2. The probable etiology for occurrence of these uncommon phenomena has been postulated.

Topics: Abducens Nerve Diseases; Acyclovir; Aged; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Visual Acuity

Longitudinal analysis of varicella-zoster virus DNA on the ocular surface of patients with herpes zoster ophthalmicus.. Clinical specimens were obtained from the bulbar conjunctival surface with a cotton-tipped swab at weekly intervals for 6 consecutive weeks from 21 patients with acute ophthalmic zoster with a skin rash duration of less than 7 days. All patients received oral valacyclovir 1000 mg three times daily for 10 days without additional corticosteroids. The swabs were analyzed by means of polymerase chain reaction for the presence of varicella-zoster virus and herpes simplex virus type 1 DNA. Conjunctival swabs were also obtained from a control group of 20 patients with cataract.. On inclusion, varicella-zoster virus DNA was present on the ocular surface of 19 of the 21 patients. Six varicella-zoster virus DNA-positive patients had no signs of ocular inflammation. All control swabs were negative for both varicella-zoster virus and herpes simplex virus DNA. The duration of varicella-zoster virus DNA detection from rash onset varied from 2 to 34 days. The number of days between the onset of herpes zoster skin rash and the latest positive varicella-zoster virus DNA test was significantly longer in patients whose age was equal to or above the median age of 66 years than in the younger patients (Mann-Whitney test: P =.0004). At 6-week follow-up, all conjunctival swabs were negative for varicella-zoster virus DNA. However, at that time, the eyes of seven patients were still inflamed.. The duration of varicella-zoster virus DNA shedding in herpes zoster ophthalmicus is highly variable and age dependent, and is probably related to the host immune response.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Conjunctiva; DNA Primers; DNA, Viral; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Time Factors; Valacyclovir; Valine; Virus Shedding

Central retinal vein occlusion (CRVO) due to herpes zoster has rarely been reported. Varicella zoster virus is a common opportunistic infection in patients with AIDS. This case report is about a 40-year-old man with herpes zoster ophthalmicus and central retinal vein occlusion of the right eye who is HIV-positive. Although the lesion resolved following treatment with intravenous acyclovir and oral steroid, the patient subsequently developed florid disc neovascularization and vitreous hemorrhage. The paper highlights CRVO as the initial presentation in an AIDS patient with herpes zoster ophthalmicus.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster Ophthalmicus; HIV Seropositivity; Humans; Male; Papilledema; Prednisolone; Retinal Neovascularization; Retinal Vein Occlusion; Vitreous Hemorrhage

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Female; Fluorescein Angiography; Genome, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Intraocular Pressure; Iridocyclitis; Male; Phlebitis; Polymerase Chain Reaction; Prednisolone; Retinal Diseases; Retinal Vein; Visual Acuity

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Antiviral Agents; Conjunctivitis, Viral; Diagnosis, Differential; Female; Giant Cell Arteritis; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Nose; Polymerase Chain Reaction

To report a case of zoster sine herpete with bilateral ocular involvement.. Case report.. A 65-year-old man showed bilateral iridocyclitis with sectoral iris atrophy and elevated intraocular pressure unresponsive to steroid treatment. No cutaneous eruption was manifest on the forehead. A target region of varicella-zoster virus DNA sequence was amplified from the aqueous sample from the left eye by polymerase chain reaction. Bilateral iridocyclitis resolved promptly after initiation of systemic and topical acyclovir treatment. Secondary glaucoma was well controlled by bilateral trabeculectomy.. Zoster sine herpete should be considered and polymerase chain reaction performed on an aqueous sample to detect varicella-zoster virus DNA for rapid diagnosis whenever anterior uveitis accompanies the characteristic iris atrophy, even in the case of bilateral involvement.

Topics: Acyclovir; Aged; Antiviral Agents; Atrophy; DNA Primers; DNA, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Intraocular Pressure; Iridocyclitis; Iris; Male; Ocular Hypertension; Polymerase Chain Reaction; Trabeculectomy; Visual Acuity

To report a case of herpes zoster sine herpete presenting with hyphema.. A 69-year-old man was referred for traumatic hyphema and corneal edema in his left eye after a sandblast exposure three weeks previously. Slit-lamp examination demonstrated hyphema, anterior chamber inflammation, mid-dilated pupil, impaired corneal sensation, and high intraocular pressure, without any facial skin lesions. Iris fluorescein angiography revealed tortuosity and extensive occlusion of iris vessels. The patient was treated with oral acyclovir and intensive topical steroids with a presumed diagnosis of severe herpes zoster uveitis.. Clinical findings improved dramatically within several days. Typical sectorial iris atrophy with pupillary sphincter dysfunction and complete loss of corneal sensation developed after the resolution of intraocular inflammation.. Herpes zoster should be considered in patients with uveitis and hyphema even in the absence of typical skin rash.

Topics: Acyclovir; Administration, Oral; Aged; Antiviral Agents; Cornea; Corneal Edema; Diagnosis, Differential; Fluorescein Angiography; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Hyphema; Iris; Male; Severity of Illness Index

The effect of antiviral agents on recovery from facial palsy in patients with zoster sine herpete (ZSH; varicella zoster virus reactivation without zoster) has not been evaluated because ZSH is difficult to diagnose early after onset. In this study, all 13 patients who received acyclovir-prednisone treatment within 7 days of onset, as confirmed by a positive PCR result, showed complete recovery. PCR-based early diagnosis of ZSH and antiviral therapy elicited an excellent outcome for recovery from facial palsy due to ZSH.

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Facial Paralysis; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Polymerase Chain Reaction; Prednisone; Time Factors

Infections with varicella zoster virus may involve the optic nerve and the retina. Different pathomechanisms have been discussed. We present a case with an autoimmune inflammatory reaction according to the clinical course.. A 69-year-old female was referred to our clinic because of suspected bilateral anterior ischemic optic neuropathy. She complained of severe visual loss the day before admission. Her ophthalmological and general history was unremarkable apart from treatment with 5 to 7.5 mg prednisolone alternately because of rheumatoid arthritis. Best corrected visual acuity was 1/15 OD and 0.1 OS. A relative afferent pupillary defect on the right eye was present. Optic disc oedema with multiple hemorrhages of the retina extending into the peripheral funds, slightly attenuated retinal arteries and macular oedema were seen fundoscopically in both eyes. THERAPY AND CLINICAL OUTCOME: After immediate treatment with steroids (initial dose 250 mg prednisolone per day) visual acuity improved. Because of a clinically suspected and serologically proven active varicella-zoster infection an additional virostatic therapy with valaciclovir was started and steroids were lowered gradually. Within 2 months, visual acuity increased to 0.8 OD and 1.0 OS. Oedema of optic discs and macula resolved and retinal hemorrhages disappeared.. A severe hemorrhagic neuro-retinitis involving the optic discs was seen in the course of a varicella-zoster infection, possibly reactivated by chronic steroid therapy of a rheumatoid arthritis. Because of the normalization of visual function an ischemic pathogenesis is unlikely. An autoimmune inflammatory reaction seems to be the predominant mechanism, supported by the good effect of steroid and valaciclovir therapy.

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Optic Nerve; Papilledema; Prednisolone; Retinitis; Valacyclovir; Valine

Delayed central neurological symptoms following herpes zoster ophthalmicus (HZO) such as "herpes zoster ophthalmicus and delayed contralateral hemiparesis" are considered to be due to ipsilateral intracranial vasculopathy. We experienced a rare case with cerebral infarction occurred in puerperium following HZO in late pregnancy. A healthy 30-year-old woman had left HZO at weeks 35 of gestation. She was given acyclovir (ACV) for external use and improved with small pigmentation on the left eye-lid. Seven weeks after the onset of HZO, she suddenly developed aphasia and right hemiparesis. Cerebral angiogram showed narrowing on M 1 segment of the ipsilateral middle cerebral artery. The occlusion was seen on peripheral portion of the angular artery on the same side. In cerebrospinal fluid (CSF), cell count was slightly elevated, but concentration of protein and sugar were normal. Varicella-zoster titer was increased in both serum and CSF. She was treated with intravenous ACV (1500 mg/day) for 10 days. On the next day after the treatment, the cell count was normalized and on 18th day, varicella-zoster titer was decreased in CSF. Higher brain function improved and no relapses occurred. This is a first case of delayed cerebral infarction occurring in puerperium preceded by herpes zoster ophthalmicus in late pregnancy, as far as we searched. We should treat carefully pregnant or lactating patients with HZO, considering delayed cerebral infarction.

Topics: Acyclovir; Adult; Antiviral Agents; Cerebral Infarction; Female; Herpes Zoster Ophthalmicus; Humans; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Puerperal Disorders

Topics: Acyclovir; Antibodies, Viral; CD4 Lymphocyte Count; Disease Progression; Eye Infections, Viral; Female; Fluorescein Angiography; Fundus Oculi; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; HIV Antibodies; HIV Seronegativity; Humans; Immunocompromised Host; Middle Aged; Prednisolone; Purpura, Thrombocytopenic, Idiopathic; Retinal Necrosis Syndrome, Acute

(1) Valaciclovir, a metabolic precursor of aciclovir, improves the bioavailability of the active compound. It is licensed for the prevention of ocular complications of herpes zoster ophthalmicus in immunocompetent subjects. (2) The clinical file on valaciclovir in this indication is very thin. Only two (uninterpretable) trials have been done, both versus aciclovir. Note that oral aciclovir has also been assessed inadequately in this indication. (3) Over 10% of patients treated with valaciclovir in the two trials had nausea or headache.

Topics: Acyclovir; Antimetabolites; Clinical Trials as Topic; France; Herpes Zoster Ophthalmicus; Humans; Treatment Outcome

This study aimed to describe a recently recognized and rare presentation of varicella zoster virus (VZV) retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome and to identify factors that may relate to improved visual outcome.. Diagnosis, treatment, and clinical course are described for three eyes of two patients with this viral infection.. Patients had decreased vision, headache, and recent zoster dermatitis. Varicella zoster virus retrobulbar optic neuritis was diagnosed on the bases of clinical, laboratory, and electrophysiologic examination results. Profound vision loss and peripheral retinitis ensued despite intravenous antiviral treatment. Combination intravenous and intravitreous antiviral injections were administered with dramatic visual recovery.. Varicella zoster virus retrobulbar optic neuritis should be considered in immunocompromised patients with visual loss. Early diagnosis and aggressive combination therapy via systemic and intravitreous routes may enable return of useful vision.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cerebrospinal Fluid; Female; Foscarnet; Fundus Oculi; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Meningitis, Viral; Optic Neuritis; Orbital Diseases; Retinitis; Skin Diseases, Viral; Visual Acuity

To investigate the ocular complications of herpes zoster ophthalmicus in patients with human immunodeficiency virus (HIV) infection.. This was a retrospective cohort study of 48 HIV-infected patients (48 eyes) treated at San Francisco General Hospital for herpes zoster ophthalmicus from December 1985 through March 1994.. All patients were initially treated with either intravenous or oral acyclovir. The median CD4 lymphocyte count at diagnosis was 48 per mm3 (range, 2 to 490 per mm3). Fifteen patients (31%) had mild or no ocular involvement. Seventeen patients (35%) had stromal keratitis, mostly mild, and two (4)% developed chronic infectious pseudodendritic keratitis. Twenty-four study patients (50%) had iritis, but only three (6%) had elevations in intraocular pressure. Two patients (4%) developed postherpetic neuralgia, and two others (4%) had zoster-associated central nervous system disease. Only two patients (4%) developed necrotizing retinitis, both in the form of the progressive outer retinal necrosis syndrome.. Excluding the patients with retinitis and central nervous system disease, the rate of sight-threatening complications in our series was lower than expected. Almost one third of study patients had no ocular complications or only mild surface epithelial disease. Although the relatively low incidence of sight-threatening disease in our study population may have been a consequence of aggressive management with acyclovir, chronic infectious pseudodendritic keratitis, retinitis, and central nervous system disease, complications of ophthalmic zoster whose pathogenesis is largely a consequence of active viral replication, were particularly devastating and difficult to manage.

Topics: Acyclovir; Adult; Antiviral Agents; Brain Diseases; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Cohort Studies; Eye Diseases; Female; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Iritis; Keratitis; Male; Middle Aged; Neuralgia; Retinal Necrosis Syndrome, Acute; Retrospective Studies

We report on a 29-year-old severely compromised acquired immunodeficiency syndrome patient who developed retrobulbar optic neuritis 5 weeks after an episode of cutaneous herpes zoster infection. During the optic neuritis, varicella zoster virus could be demonstrated in the cerebrospinal fluid. The neuritis responded well to treatment with foscarnet, but, 3 weeks into therapy, varicella zoster retinitis developed. Additional treatment with intravenous acyclovir stopped progression of the retinitis and resulted in healing of the retinal lesions. This case suggests that retrobulbar optic neuritis can be regarded as a prodrome of imminent acute retinal necrosis. Early recognition and prompt therapy with combined antivirals may prevent the development of this devastating ocular complication of varicella zoster infection.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Female; Foscarnet; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Optic Neuritis; Visual Acuity

To assess a two-drug combination of antiviral therapy for the progressive outer retinal necrosis syndrome (PORN), given the current poor outcome with acyclovir alone.. A retrospective review was performed on six consecutive patients who were diagnosed with PORN and were treated with various combinations of intravenous or oral plus intravenous antiviral therapy. The relative efficacies of these modalities were compared.. Six eyes of six patients showed active retinitis at the time of presentation. Three patients had unilateral retinitis, and the remaining patients had necrotic, end-stage disease in their fellow eye. All the patients were treated with combination therapy, consisting of either ganciclovir and acyclovir (three patients), foscarnet and ganciclovir (two patients), or foscarnet and acyclovir (one patient). Standard induction doses were employed. During the combination therapy, all six eyes showed resolution of the retinitis, manifested by complete fading of the original retinal lesions and an absence of new lesion formation. At the final follow-up, the areas of prior active retinitis had resolved and remained quiescent. A mild recurrence developed in one eye when ganciclovir and foscarnet were both tapered to a single daily dose. This recurrence promptly resolved with reinduction (twice daily) dosing. Two patients maintained a visual acuity of 20/50 or better in their involved eye for the duration of follow-up (38 and 27 weeks, respectively). One patient maintained a visual acuity of 20/40 for 14 weeks. The remaining three patients had macula-off retinal detachments despite resolution of active retinitis. In addition, for the duration of follow-up, one of the three patients with unilateral disease had retinitis in the uninvolved eye; all three uninvolved fellow eyes maintained a visual acuity of 20/20. One patient had progressive optic atrophy.. Prolonged combination antiviral therapy for PORN may successfully arrest the progression of retinitis, maintain remission, and prevent involvement of the fellow eye. Furthermore, if aggressive therapy is begun early, good vision may be preserved.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus Retinitis; Disease Progression; Drug Therapy, Combination; Female; Follow-Up Studies; Foscarnet; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Recurrence; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Visual Acuity

To characterize further a chronic epithelial keratitis caused by varicella-zoster virus infection in patients with acquired immunodeficiency syndrome (AIDS).. Patients with AIDS and chronic epithelial keratitis associated with varicella-zoster virus from 3 institutions were identified. Patient records were reviewed retrospectively for the following data: medical and demographic characteristics, techniques of diagnosis, physical findings, course, response to treatment, and outcome.. Sixteen patients were studied. CD4+ T-lymphocyte cell counts were available in 11 patients, with a median of 0.034 x 10(9)/L (range, 0-0.094 x 10(9)/L). Two patients had no history of a zosteriform rash. In the remaining patients, the interval between rash and keratitis ranged from 0 days to 6 years. In all cases, the keratitis was chronic and characterized by gray, elevated, dendriform epithelial lesions that stained variably with fluorescein and rose bengal. The peripheral and midperipheral cornea was most commonly affected, and, in 13 of the 16 patients, the lesions crossed the limbus. Pain was a prominent feature, occurring in 12 of 16 patients. In 9 of 12 patients tested, varicella-zoster virus was identified by culture, direct fluorescent antibody testing, polymerase chain reaction testing, or a combination of these studies, with direct fluorescent antibody testing (6 of 8 positive results) and polymerase chain reaction testing (3 of 3 positive results) appearing to be the most sensitive. Response to antiviral medication was variable.. In patients with AIDS, varicella-zoster virus may cause a chronic infection of the corneal epithelium. The keratitis is characterized by dendriform lesions, prolonged course, and frequently by extreme pain. It can occur without an associated dermatitis.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Aged; Antiviral Agents; Arabinofuranosyluracil; CD4 Lymphocyte Count; Chronic Disease; Epithelium, Corneal; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Male; Middle Aged; Retrospective Studies

We report a case of bilateral acute retinal necrosis (ARN) following an acute optic neuromyelitis (AONM) in an immunodepressed patient (T CD4 lymphocyte count under 50/mm3) suffering from acquired immunodeficiency syndrome (AIDS). Despite the medical treatment the evolution led to blindness by bilateral total retinal detachment. The neuro-ophthalmological features occurred prior to the retinal manifestation, and the acute optic neuromyelitis occurred after a spreading zoster. The varicella-zoster virus (VZV) seemed to be involved because of recurring cutaneous zoster, spreading of this zoster just before the AONM, previous reports showing a link between VZV and AONM, and VZV and ARN. However, our patient had first an AONM responding well to corticosteroid therapy following one month later by an ARN leading to blindness despite the antiviral treatments received as soon as possible. There is a chronical viremia+ in immunodepressed patients with recurring and spreading zoster. The rupture of the hemato-encephalic barrier observed in AONM could facilitate the invasion of the eye by the virus, leading to an ARN. This hypothesis could explain the two complications due to the VZV, the AONM and the ARN, the first one is of dysimmunitary origin and the second one could probably result of a direct viral attack of the retina. This should incite to treat as soon as possible each retrobulbar optic neuritis in patients with AIDS, especially if past history of zoster.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Blood-Brain Barrier; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Neuromyelitis Optica; Retinal Necrosis Syndrome, Acute; Treatment Refusal

A case of recurrent unilateral varicella-zoster virus (VZV) retinitis is reported. The retinitis was characterized by arteriolitis and retinal necrosis with secondary chorioretinal atrophy localized in the periphery of the supratemporal quadrant of the retina. Polymerase chain reaction analysis of aqueous humor demonstrated VZV DNA in both the initial and recurrent episode. The Goldmann-Witmer coefficient for VZV IgG was elevated. The initial VZV retinitis was successfully treated with acyclovir and corticosteroids. Three years later, high-dose corticosteroids alone were used to treat idiopathic facial nerve palsy. One month after concluding corticosteroids therapy, the VZV retinitis recurred in the same eye, suggesting that administration of the high-dose corticosteroids caused VZV reactivation and induced recurrence of VZV retinitis.

Topics: Acyclovir; Adult; Antibodies, Viral; Aqueous Humor; DNA, Viral; Drug Therapy, Combination; Facial Paralysis; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Prednisolone; Recurrence; Retinal Necrosis Syndrome, Acute; Retinitis; Virus Activation

We conducted a prospective study of 100 consecutive Ethiopian patients with herpes zoster ophthalmicus (HZO); this study revealed a high incidence of HZO among the young (mean age, 35 years). Eighty-one (95%) of 85 patients who underwent serological testing were seropositive for antibodies to human immunodeficiency virus (HIV). Unlike previous investigators, we found a marked increase in the incidence and severity of eyelid (25%) and ocular (78%) complications as well as postherpetic neuralgia (55%). Visual loss occurred in 56% of the cases. Lack of medication, delay in presentation, severity of HIV-related HZO, and application of herbal medications adversely affected the outcomes for these patients. We conclude that all patients with HZO, especially those younger than 45 years of age, should be screened for HIV infection. Because HZO is a vision-threatening problem, all health care workers should become aware of its management.

Topics: Acyclovir; Adolescent; Adult; Aged; Female; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Male; Middle Aged; Prospective Studies

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster Ophthalmicus; Humans; Optic Neuritis; Prednisolone; Retinitis

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Disease Progression; Drug Therapy, Combination; Female; Follow-Up Studies; Ganciclovir; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Injections; Retinal Necrosis Syndrome, Acute; Vitreous Body

Only few studies focus on ocular motor paralyses in herpes zoster ophtalmicus. We report 2 cases of complete ptosis resulting from paralysis of the superior lid levator, appearing at day 6 and 7 of an ophtalmic herpes zoster under treatment with acyclovir.. Case 1: A 68 year old woman presented an history of ophtalmic herpes zoster with kerato-conjunctivitis and uveitis treated with acyclovir. At the third day of the treatment and 7th day of the ophtalmic zoster, an incomplete paralysis of the oculomotor nerve appeared resulting in a complete ptosis. The treatment was carried on until the 21st day without improvement. Four months later, all symptoms had completely cleared. CASE 2: A 66 year old woman was treated with acyclovir for an ophtalmic herpes zoster without ocular involvement. At the 4th day of the treatment and 6th day of the onset of the ophtalmic zoster, a paralytic ptosis and a acute epithelial keratitis appeared. Acyclovir treatment was continued for 10 days. The ptosis resolved gradually during 2 months.. The manifestation of a complete ptosis with paralysis of the oculomotor nerve or of one of its branch is rarely seen in ophtalmic herpes zoster. However minor symptoms are often detected when patients were carefully examined with regard to external ocular movements. The physiopathological mechanism are discussed about. The possible action of an early antiviral treatment on the prevention of these complications is not known. In our two cases, a paralytic ptosis broke out suddenly, even under treatment with acyclovir for respectively 3 and 4 days. For future prospective studies about antiviral drugs for ophtalmic herpes zoster, a systematic evaluation of these neurological symptoms would be interesting.

Topics: Acyclovir; Aged; Antiviral Agents; Blepharoptosis; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Oculomotor Nerve Diseases

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster Ophthalmicus; Humans; Prodrugs; Valacyclovir; Valine

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Brain; Cerebrospinal Fluid; Child, Preschool; Female; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Immunoglobulin G; Immunoglobulin M; Magnetic Resonance Spectroscopy; Prednisone; Radiography

The purpose of this study was to describe the clinical characteristics and course of peripheral ulcerative keratitis (PUK) secondary to herpes varicella-zoster virus in patients with the acquired immunodeficiency syndrome (AIDS). Three AIDS patients with ocular herpes zoster infection (mean age at onset, 33.0 years; range, 30-42) developed PUK. The three patients had skin involvement, and two of them had bilateral keratouveitis. All were treated with high-dose oral acyclovir (4 g/day) with or without topical antiviral therapy. Two of the patients responded well to oral acyclovir, but one of them stopped the treatment, and bilateral progressive outer retinal necrosis and lethal encephalitis developed. The third patient had a recurrent episode of inflammation with PUK, extensive stromal scarring, and deep neovascularization. AIDS patients with herpes varicella-zoster virus infection may have severe and protracted corneal manifestations, including PUK. The correct diagnosis and aggressive early long-term systemic antiviral treatment must be instituted to control inflammation, ulcer progression, and complications.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Anti-Inflammatory Agents; Antiviral Agents; Corneal Ulcer; Herpes Zoster Ophthalmicus; Humans; Male; Ophthalmic Solutions; Prednisolone; Recurrence; Skin Diseases, Viral; Uveitis

The authors describe an immunocompetent patient who developed multiple recurrent branch retinal artery occlusions (BRAOs) associated with the varicella zoster virus (VZV).. A 69-year-old woman with mild bilateral vitritis developed superior and inferior BRAOs in her right eye with decreased visual acuity to 20/40, and a peripheral BRAO inferotemporally in her left eye. One month later, the inferotemporal BRAO progressed proximally in her left eye with a decrease of visual acuity to 20/40. After an extensive negative systemic evaluation, she underwent a diagnostic pars plana vitrectomy of her right eye.. Vitreous fluid was positive for VZV DNA by polymerase chain reaction (PCR). The patient was treated with intravenous acyclovir and systemic oral steroids. After remaining disease free for 3 months, the patient had two recurrences: 1) a mild vitritis and 2) development of a new superior temporal artery occlusion in the left eye. Both recurrences were treated with oral acyclovir and systemic steroids. The patient remained recurrence free for 12 months on a maintenance dose of oral acyclovir, and for 4 additional months without acyclovir.. Varicella zoster virus can be associated with the syndrome of multiple recurrent BRAOs. The diagnosis of VZV-associated BRAO can be established by PCR of intraocular fluid.

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; DNA, Viral; Female; Fluorescein Angiography; Fundus Oculi; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunocompetence; Polymerase Chain Reaction; Prednisone; Recurrence; Retinal Artery Occlusion; Visual Acuity; Vitrectomy; Vitreous Body

To describe the clinical course of varicella-zoster optic neuropathy preceding acute retinal necrosis in patients with acquired immunodeficiency syndrome.. Case series.. Two tertiary care centers in San Diego, Calif, and London, England.. Three human immunodeficiency virus-positive men with previous cutaneous zoster infection, optic neuropathy, and necrotizing retinitis.. All patients had an episode of zoster dermatitis treated with acyclovir. Visual loss consistent with an optic neuropathy ensued, followed by typical herpetic retinitis. The cause of visual loss was not suspected to be varicella-zoster until after the retinitis occurred. Despite aggressive medical treatment, 4 of 6 eyes progressed to retinal detachment.. Varicella-zoster may cause an optic neuropathy in patients with acquired immunodeficiency syndrome, especially in those with previous shingles. A high index of suspicion is necessary to establish the diagnosis and begin early antizoster treatment.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antigens, Viral; Antiviral Agents; Dermatitis; Fluorescein Angiography; Fundus Oculi; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunohistochemistry; Male; Middle Aged; Optic Nerve Diseases; Retina; Retinal Necrosis Syndrome, Acute; Skin Diseases, Viral; Visual Acuity; Vitreous Body

Progressive outer retinal necrosis is a destructive retinopathy found in patients with acquired immune deficiency syndrome. Treatment of this disorder has been unsuccessful in reported patient series, with the patients experiencing profound bilateral loss of vision.. We treated six patients with combination antiviral therapy, usually with intravenous foscarnet and either ganciclovir or acyclovir.. These six patients retained a visual acuity of 20/100 or better in at least one eye for the remainder of their lives (a period > 4 months for each patient). Retinal detachments developed in four patients, for which vitrectomy and silicone oil tamponade were required.. A combination of intravenous antiviral therapy and aggressive vitrectomy techniques to repair any associated detachments may allow the preservation of useful visual acuity in patients with progressive outer retinal necrosis. This is the first reported series of successful long-term treatment of patients with this disorder.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Female; Foscarnet; Fundus Oculi; Ganciclovir; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Infusions, Intravenous; Male; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Silicone Oils; Visual Acuity; Vitrectomy

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Aqueous Humor; Base Sequence; Dexamethasone; DNA Primers; DNA, Viral; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Iridocyclitis; Molecular Sequence Data; Ophthalmic Solutions; Polymerase Chain Reaction

Retinal infections caused by the varicella-zoster virus (VZV) have been reported in immunocompetent and immunocompromised individuals. Two cases of a VZV-related retinitis are described with the characteristic features of the recently described progressive outer retinal necrosis (PORN) syndrome. Both patients suffered from the acquired immunodeficiency syndrome (AIDS) with greatly reduced peripheral blood CD4+ T lymphocyte counts, and presented with macular retinitis without vitritis. The disease was bilateral in one case and unilateral in the other. The clinical course was rapidly progressive with widespread retinal involvement and the development of rhegmatogenous retinal detachment with complete loss of vision in the affected eyes despite intensive intravenous antiviral therapy. VZV DNA was identified in vitreous biopsies, by molecular techniques based on the polymerase chain reaction (PCR), in both patients. At present, the use of very high-dose intravenous acyclovir may be the best therapeutic option in these patients for whom the visual prognosis is poor. Intravitreal antiviral drugs could also contribute to the management of these cases.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; DNA, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Necrosis; Polymerase Chain Reaction; Prognosis; Retina; Retinal Detachment; Retinitis; Vitreous Body

Topics: Acyclovir; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Treatment Outcome

Topics: Acyclovir; Aged; Dexamethasone; Drug Therapy, Combination; Herpes Zoster Ophthalmicus; Humans; Male; Optic Neuritis; Papilledema; Visual Acuity

Topics: Acyclovir; Herpes Zoster Ophthalmicus; Humans; Pain; Randomized Controlled Trials as Topic

A 61-year old man with a history of arterial hypertension suffered a left HZO, and was treated with acyclovir. Three weeks later he suddenly developed moderate left hemiparesis particularly of the leg, severe paresis of the right leg, aphasia and somnolence. Treated with IV acyclovir and high-dose corticosteroids deterioration of the right hemiparesis was apparent. Serological and CSF-studies showed acute varicella-zoster virus infection with intrathecal antibody synthesis (antibody specificity index 2.7). On the third day CT scan revealed infarctions in the territory of both anterior cerebral arteries, at the fifth day additionally left striatocapsular infarction. Selective carotid arteriogram showed bilateral occlusions of anterior cerebral arteries in their proximal segment. With a mean delay of seven weeks granulomatous vasculitis is a rare complication of HZO, leading commonly to ischemic infarctions in the region of the middle cerebral artery. Trigeminovascular connections are the probable pathway of virus-transmission from the trigeminal nerve to ipsilateral branches of the circle of Willis. Because of the presumed pathogenesis immediate therapy with high-dose corticosteroids and acyclovir is justified.

Topics: Acyclovir; Antiviral Agents; Arteritis; Cerebral Angiography; Cerebral Arterial Diseases; Cerebral Infarction; Dominance, Cerebral; Follow-Up Studies; Granuloma; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Tomography, X-Ray Computed

Herpes zoster ophthalmicus usually has a typical appearance. However, if the disease is limited to the nasociliary branch of the trigeminal nerve, the ocular appearance may be confusing. Hutchinson in 1865 first noted that involvement of the external nasal branch of the fifth cranial nerve was associated with an increased incidence of ocular zoster. A case of herpes zoster ophthalmicus is presented that clinically resembled an ocular complication of sinus disease. The presence of a localized vesicular rash at the nasal tip assisted in an early diagnosis. Although this sign is known amongst ophthalmologists, its importance in rhinology is stressed. An anatomical explanation of Hutchinson's sign is given and the treatment of herpes zoster ophthalmicus is briefly discussed.

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Herpes Zoster Ophthalmicus; Humans; Male; Paranasal Sinus Diseases

Postherpetic neuralgia is one of the most common, but also one of the most difficult conditions to treat. This condition mainly involves trigeminal, intercostal and sciatic nerves and the brachial plexus area. It mostly appears in patients older than 60 years. Although pain is a transient condition, the pain of postherpeutic neuralgia may become intractable, disabling an may decrease the quality of the patient's life. We studied 30 patients affected by ophthalmic postherpetic neuralgia, appearing, some months after fronto-orbital cutaneous eruption. All patients received nicardipine retard, decreasing gradually, 40 mg/day for 2 weeks. The monitoring of pain was performed using the visual analogue score of Scott-Huskissonn. The results show an improvement in 'pain relief'.

Topics: Acyclovir; Aged; Aged, 80 and over; Analgesics; Antiviral Agents; Calcium Channel Blockers; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Neuralgia; Nicardipine; Ophthalmic Nerve; Pain Measurement

Topics: Acyclovir; Administration, Topical; Aged; Follow-Up Studies; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Neuralgia

Herpes zoster ophthalmicus is a form of herpes zoster. Approximately 10 to 25 percent of zoster cases are ophthalmicus. The process is caused by reactivation of latent varicella virus affecting the fifth cranial nerve. Recognition of signs and symptoms leading to early diagnosis and treatment with acyclovir may alter the course and diminish damage to ocular structures.

Topics: Acyclovir; Herpes Zoster Ophthalmicus; Humans

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

The acute retinal necrosis syndrome (ARN) is caused by the Varicella zoster virus or the Herpes simplex virus. However the dosage and duration of the antiviral therapy for prevention of an infection in the second eye or treatment of an infection on an affected fellow eye is still not known. We discuss the timing of a possible steroid treatment and demonstrate in a case report how an acute retinal necrosis syndrome in a fellow eye was successfully treated.. First eye: A 27-year-old not immunocompromised patient (HIV-negative) showed 2 months after a febrile state an acute iritis in the right eye. 14 days later an acute retinal necrosis syndrome was observed. The patient received Acyclovir 3 x 750 mg i.v. for 6 days, and afterwards 5 x 200 mg orally for 5 days. The patient developed an inoperable retinal detachment despite therapy. Second eye: Eight days later the fellow eye developed a localized retinal necrosis. Varicella zoster DNA was found in the aqueous humor using the polymerase chain reaction (PCR). The antiviral therapy with Acyclovir was increased from 1.1 g q 12 h (2 x 15 mg/kg/d) to 1.0 g q 8 h (3 x 12.5 mg/kg/d). After 4 weeks the i.v. therapy was followed by an oral therapy of 5 x 800 mg for 12 weeks. This dosage was reduced to 5 x 400 mg for another 12 weeks. The oral therapy with corticosteroids started on the 11th day with 100 mg Prednisone, in slowly reducing dosage during 18 weeks. The fellow eye recovered fully with a visual acuity of 20/20 after 6 months.. The disease started in the fellow eye with an acute iritis and a secondary glaucoma. These symptoms can be a characteristic prodroma of an acute retinal necrosis syndrome caused by a varicella zoster- or Herpes simplex virus infection, which was not recognized first. Whether a long-term therapy (as described above) is necessary or not is unclear on the basis of a single case report, but we currently recommend the high-dose treatment regimen until further data emerge.

Topics: Acyclovir; Administration, Oral; Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Fluorescein Angiography; Follow-Up Studies; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Intraocular Pressure; Male; Recurrence; Retinal Necrosis Syndrome, Acute; Visual Acuity

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

Five patients with acquired immunodeficiency syndrome (AIDS) and presumed varicella-zoster virus retinopathy had recurrence of retinopathy after stabilization with initial intravenous antiviral therapy. Recurrences were recognized as increased retinal opacification at the borders of preexisting lesions or as new lesions. In four of the five patients, recurrences were temporally associated with a reduction in the amount of antiviral medication being received. Changes included switch from intravenous to oral acyclovir (two patients), taper of oral acyclovir (one patient), and discontinuation of medications (one patient). In four patients disease was initially unilateral; in three of these four, disease subsequently developed in the previously unaffected fellow eye at the time of recurrence. The median time from stabilization of disease to recurrence was 51 days (range, 14 to 90 days). In contrast to the management of varicella-zoster virus retinopathy in immunocompetent patients and varicella-zoster virus lesions of the skin, varicella-zoster virus retinopathy in patients with AIDS appears to require chronic suppressive antiviral therapy to prevent recurrences. In this respect it is similar to other opportunistic retinal infections in patients with AIDS. The best drugs and optimal treatment regimens for maintenance antiviral therapy remain unknown.

Topics: Acyclovir; Administration, Oral; Adult; AIDS-Related Opportunistic Infections; Foscarnet; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Male; Recurrence; Retinal Diseases

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

Clinical course, early and late complications as well as treatment of ophthalmic zoster in 70 hospitalized patients are presented. Authors pay the attention to early treatment (general and topical) with Zovirax in prevention of ocular complications.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Female; Herpes Zoster Ophthalmicus; Humans; Inosine Pranobex; Male; Middle Aged

Topics: Acyclovir; Herpes Zoster Ophthalmicus; Humans; Time Factors

A healthy 56-year-old man developed left-sided herpes zoster ophthalmicus, accompanied initially by ipsilateral anterior uveitis and increased intraocular pressure. Although he was treated in the subacute phase (5 days after skin eruption) with adequate oral doses of acyclovir for 10 days, the condition was later complicated by a left sectorial anterior ischemic optic neuropathy. The pathogenesis of this rare complication is discussed in this article.

Topics: Acyclovir; Fluorescein Angiography; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Ischemia; Male; Middle Aged; Optic Nerve; Papilledema; Prednisone; Visual Fields

Topics: Acyclovir; Administration, Topical; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Inflammation; Steroids; Virus Replication

In a prospective open trial 40 patients suffering from acute herpes zoster ophthalmicus were treated with systemic acyclovir. An additional 10 patients were treated by topical acyclovir alone and dexamethasone eye-drops were administered to 5 of them to suppress ocular inflammation. In the topical treatment group the period of new skin lesion formation and progression of ocular inflammatory signs were significantly prolonged. Therapy with systemic acyclovir however resulted in a quick and complete resolution of ocular inflammation in all patients. Chronic ocular inflammation developed in 4 out of 10 patients treated with topical acyclovir. We consider chronic ocular zoster as a distinct clinical entity, possibly expressing a failing local immune response against VZV.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Bromodeoxyuridine; Chronic Disease; Conjunctivitis; Dexamethasone; Drug Administration Routes; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Male; Middle Aged; Prospective Studies; Scleritis; Skin Diseases; Uveitis, Anterior

Systemic acyclovir (ACV), a new potent anti-herpes drug, was shown to reduce effectively the morbidity in the acute phase of herpes zoster ophthalmicus (AHZO). Using high dose oral ACV (5 X 800 mg/day) our aim in this study was: (1) to compare disease profiles in the ACV-treated group and in a group of zoster patients having had no ACV, analysed retrospectively; (2) to establish if high-dose ACV was able to prevent severe long term complications of AHZO; and (3) to determine the present role of corticosteroids in AHZO. From 1984 to 1988, 48 patients with AHZO of less than 3 days' duration were included. All patients received at least 7 days of oral ACV (5 X 800 mg/d) associated with topical ACV. Steroids were not given unless severe uveitis occurred. Follow-up was 2 years in 43 patients and 1 year in all 48 patients. Main conclusions from our study are: 1. Ocular involvement occurred in 67% of ACV-treated cases, a rate comparable to our retrospective group (59%) and to the literature (71%). However the rate of severe long term complications was minimal (4%) when compared to our non-treated retrospective group (21%). 2. Steroid treatment was not necessary in any of the ACV-treated patients. 3. ACV was well tolerated and did not have to be discontinued in any of the patients. High dose ACV and avoidance of steroids seems to eliminate the severe complications of AHZO.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Child; Dose-Response Relationship, Drug; Drug Tolerance; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies; Uveitis

We compared the frequency of severe ocular complications secondary to Herpes Zoster Ophthalmicus (HZO) in 232 patients. They were divided into three groups: 1) patients without treatment (n = 164); 2) patients treated adequately (n = 48) with acyclovir (ACV; 5 x 800 mg/d orally and ophthalmic ointment 5 x /d for a minimum of 7 days, given within three days after skin eruption); and, 3) patients treated inadequately (n = 20) with ACV (only topical treatment, insufficient doses, interrupted treatment, delayed treatment). Patients with no treatment or with inadequate treatments showed the same frequency of severe ocular complications (21% (34/164) and 25% (5/20), respectively). In contrast, when adequate treatment of ACV was given complications occurred in only 4% (2/48) of cases. This study emphasizes the need for prompt (within three days after skin eruption) and adequate (5 x 800 mg/d for at least 7 days) treatment of ACV to prevent the severe complications of HZO.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Child; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies

The Laser Flare Cell Meter (LFCM, Kowa FC-1000), an instrument measuring aqueous flare and cells in a quantitative, objective and non-invasive way, has been mainly used so far to measure inflammation in clinical and experimental research. In the light of some illustrative examples, its practical clinical usefulness is presented; the LFCM was found to be specially helpful in 3 types of situations. 1. In acute anterior uveitis (AAU) patients, precise LFCM monitoring of inflammation made it possible to avoid excessive corticosteroid therapy, mainly by more rapid and controlled tapering at the end of an inflammatory episode, so possibly minimizing steroid side effects in a group of patients prone to numerous uveitis recurrences. In a steroid-responder patient it allowed successful treatment of a flare-up of AAU with a combination of systemic and topical diclofenac (Voltaren), a potent nonsteroidal antiinflammatory drug. 2. LFCM monitoring of inflammation in patients undergoing laser treatments allowed optimal adjustment of antiinflammatory therapy. Diclofenac drops (Voltarene Ophta), were sufficient to treat inflammation in all patients, undergoing Nd-YAG laser posterior capsulotomy or Argon laser trabeculoplasty. 3. In patients with acyclovir treated herpes simplex or herpes zoster uveitis corticosteroid treatment should be avoided whenever possible, because of the tendency to develop steroid dependency. LFCM monitoring of this group of patients gave a precise evolutionary pattern of inflammation and permitted to avoid steroid treatment in many patients.

Topics: Acyclovir; Administration, Oral; Anterior Chamber; Dexamethasone; Diclofenac; Drug Therapy, Combination; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Male; Middle Aged; Ophthalmic Solutions; Ophthalmoscopes; Uveitis, Anterior

Topics: Acyclovir; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Myositis; Oculomotor Muscles; Orbital Diseases; Steroids; Tomography, X-Ray Computed

Topics: Acyclovir; Aged; Female; Herpes Zoster Ophthalmicus; Humans; Meningoencephalitis

Topics: Acyclovir; Adult; Female; Herpes Zoster Ophthalmicus; HIV Seropositivity; Humans; Injections, Intravenous; Methylprednisolone Hemisuccinate; Optic Neuritis; Tomography, X-Ray Computed

A 71-year-old man presented with herpes zoster ophthalmicus and ocular involvement. Following the institution of intravenous therapy with acyclovir, the patient developed fever, hemoptysis, and a pleural friction rub. A ventilation-perfusion lung scan showed no defects; roentgenograms showed bilateral infiltrates and a left-sided pleural effusion. The fever abated promptly following discontinuation of acyclovir, and radiographic abnormalities resolved over ten days. No other anti-infective therapy was given. To our knowledge, the syndrome of fever, pulmonary infiltrates, and pleural effusion following use of acyclovir has not been previously reported.

Topics: Acyclovir; Aged; Fever; Herpes Zoster Ophthalmicus; Humans; Lung; Lung Diseases; Male; Pleural Effusion; Radiography

A 57-year-old patient nonimmunosuppressed who had zoster ophthalmicus associated to contralateral hemiplegia is presented. We noticed on the CT scan an infarction of left caudate nucleus, as well as in the angiography signs of vasculitis. We comment on the clinical and diagnosis features and suggest possible benefit effects of the treatment with acyclovir.

Topics: Acyclovir; Brain; Cerebral Infarction; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Tomography, X-Ray Computed

Topics: Acyclovir; Ambulatory Care; Herpes Zoster Ophthalmicus; Hospitalization; Humans

Topics: Acyclovir; Aged; Disease Susceptibility; Eyelid Diseases; Female; Herpes Zoster Ophthalmicus; Humans

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

We treated two patients with herpes zoster ophthalmicus in whom hyphema and hemorrhagic glaucoma occurred. Case 1 complained of facial skin eruption, and was given intravenous acyclovir for 7 days. Hyphema and high intraocular pressure occurred in the left eye 10 days after the onset of the skin eruption. Case 2 had severe pain and blisters on her face, and was given intravenous acyclovir for 7 days. An intracameral hemorrhage and glaucoma developed in the right eye 15 days after the onset of the skin lesion. Intravenous acyclovir may be necessary for longer than 7-day periods if the iridocyclitis remains.

Topics: Acyclovir; Aged; Aged, 80 and over; Dermatitis; Eye Diseases; Face; Glaucoma; Hemorrhage; Herpes Zoster Ophthalmicus; Humans; Hyphema; Injections, Intravenous; Male

Topics: Acyclovir; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Time Factors

Topics: Acute Disease; Acyclovir; Administration, Topical; Anti-Inflammatory Agents; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prospective Studies

Patients who are homosexual, intravenous drug abusers, or have received multiple blood transfusions are at greater risk to contract the immunosuppressive disorders of acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC). These persons also have a greater chance of developing serious neurologic complications after an episode of Herpes zoster. We present two cases which emphasize the serious complications of Herpes zoster ophthalmicus in such patients. Since systemically administered acyclovir may shorten the disease course and reduce the complications of Herpes zoster in immunocompromised individuals, the authors favor treatment of all such patients who have Herpes zoster ophthalmicus with a seven-day course of high-dose (30 mg/kg/day) intravenous acyclovir. To minimize serious neurologic complications in such patients, treatment should be instituted immediately before the results of human immunodeficiency virus (HIV) testing are known.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Complex; Female; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Male; Middle Aged; Nervous System Diseases; Risk Factors

The incidence and severity of herpes zoster ophthalmicus have increased because of the growing number of immunocompromised patients. Uveitis and keratitis are the most common inflammatory complications. Corneal exposure from scarring and contraction of the upper lid may require reconstructive plastic surgery. Preliminary studies of oral acyclovir, specifically targeted at preventing ocular complications, are encouraging.

Topics: Acyclovir; Antiviral Agents; Conjunctivitis, Viral; Eyelid Diseases; Female; Herpes Zoster Ophthalmicus; Humans; Immune Tolerance; Keratitis; Male; Orbital Diseases; Retinal Diseases; United States; Uveitis, Anterior

A 17-month-old boy developed herpes zoster ophthalmicus (HZO) and delayed contralateral hemiparesis following intrauterine varicella exposure. CT demonstrated multiple areas of hypodensity in the left basal ganglia, and angiography showed occlusion of left lenticulostriate arteries. As in most adults with HZO and delayed hemiparesis, this infant had a self-limiting course with excellent recovery.

Topics: Acyclovir; Basal Ganglia; Chickenpox; Female; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Infant; Male; Pregnancy; Pregnancy Complications, Infectious; Prenatal Exposure Delayed Effects; Radiography

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Aged; Child; Child, Preschool; Female; Herpes Zoster Ophthalmicus; Humans; Infusions, Intravenous; Keratitis, Dendritic; Male; Middle Aged; Recurrence

Topics: Acyclovir; Adolescent; Adult; Child; Corneal Ulcer; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis; Male; Middle Aged; Ointments; Prognosis

The syndrome of granulomatous angiitis related to varicella zoster virus infection often manifests as herpes zoster ophthalmicus followed by contralateral hemiplegia. Forty-five cases have been reported to date, and the authors' experience with two additional cases seen in a one-year period is described. Given the frequency of both stroke and herpes zoster ophthalmicus in an aging population, the authors postulate that granulomatous angiitis is underdiagnosed. There is need for increased awareness of this disease by the non-neurologist. Diagnostic and therapeutic considerations are reviewed.

Topics: Acyclovir; Adult; Aged; Angiography; Aphasia; Cerebrovascular Disorders; Diagnostic Errors; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Steroids; Syndrome; Vasculitis

Topics: Acyclovir; Adult; Blindness; Herpes Zoster Ophthalmicus; Humans; Male; Optic Atrophy; Optic Neuritis

The case of a 67 year old male who developed severe encephalitis associated with herpes zoster ophthalmicus is described. Encephalitis occurred in the absence of cutaneous dissemination and recovery followed treatment with Acyclovir.

Topics: Acyclovir; Aged; Antibodies, Viral; Encephalitis; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male

Topics: Acyclovir; Ampicillin; Child; Child, Preschool; Cloxacillin; Drug Therapy, Combination; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Lupus Erythematosus, Systemic; Nephrotic Syndrome

A retrospective analysis of 171 patients with herpes zoster ocular infection has been carried out to determine the effect of treatment with either topical acyclovir, topical steroids, or a combination of both. Acyclovir was superior to steroids and to the combination. Treatment with topical acyclovir was on average 54 days compared with 200 days with steroids, and recurrences were 6% with acyclovir compared with 50% with steroids.

Topics: Acyclovir; Administration, Topical; Herpes Zoster Ophthalmicus; Humans; Recurrence; Retrospective Studies; Steroids; Time Factors

Motor lesions following herpes zoster are quite common. Hemiparesis, paraparesis, pareses of the facial and other cranial nerves as well as segmental pareses can be observed. We report on a patient suffering from zoster ophthalmicus complicated by paresis of the third cranial nerve. As a cause, a partial brain stem-encephalitis was diagnosed. The patient recovered after antiviral treatment (Aciclovir, Inosiplex).

Topics: Acyclovir; Brain Stem; Encephalitis; Herpes Zoster Ophthalmicus; Humans; Inosine Pranobex; Male; Middle Aged; Ophthalmoplegia

Topics: Acyclovir; Herpes Zoster Ophthalmicus; Humans; Steroids; Uveitis

Topics: Acyclovir; Adrenal Cortex Hormones; Aged; Diagnosis, Differential; Eye Diseases; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Skin Diseases

Topics: Acyclovir; Cytomegalovirus Infections; Eye Diseases; Herpes Zoster Ophthalmicus; Herpesviridae Infections; Humans; Keratitis; Keratitis, Dendritic

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Infant, Newborn; Male

Four patients with herpes zoster ophthalmicus and delayed contralateral hemiparesis are described, and their findings are compared with those in patients previously reported in the English language literature. The current patients evidenced multifocal ipsilateral cerebral angiitis by angiography and multifocal infarcts in the distribution of the ipsilateral middle cerebral artery by computed tomographic scanning. Cerebrospinal fluid showed mononuclear pleocytosis, positive oligoclonal bands, and an elevated immunoglobulin G index. Two patients were treated with corticosteroids and acyclovir, and 1 with corticosteroids alone, all without apparent response. Necrotizing angiitis ipsilateral to the herpes zoster ophthalmicus was demonstrated postmortem in 1 patient with multifocal cerebral infarction and progressive leukoencephalopathy. Neither herpes varicella zoster immunocytochemical reactivity nor viral inclusions were seen. The leukoencephalopathy associated with herpes varicella zoster either may be caused by cerebral angiitis or, as previously reported, may be a temporally remote manifestation of persistent herpes varicella zoster infection. The cerebral angiitis associated with herpes varicella zoster is histologically similar to granulomatous angiitis, and both may be related to herpes varicella zoster infection of the cerebral vasculature.

Topics: Acyclovir; Aged; Brain; Cerebral Arterial Diseases; Cerebral Infarction; Dexamethasone; Dominance, Cerebral; Electroencephalography; Female; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prednisone; Tomography, X-Ray Computed; Vasculitis

Topics: Acyclovir; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Uveitis