acyclovir and Keratoconjunctivitis

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; Chickenpox; Clinical Trials as Topic; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Infant, Newborn; Keratitis, Dendritic; Keratoconjunctivitis; Male; Vidarabine

Topics: Acyclovir; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Infant, Newborn; Keratitis, Dendritic; Keratoconjunctivitis; Male; Vidarabine

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

To review the clinical characteristics and visual outcomes of patients with bilateral herpetic keratitis.. Retrospective, noncomparative, observational case series.. A retrospective review of medical records of 544 patients with herpes simplex virus (HSV) eye disease treated between January 1996 and September 2001 was performed at the Department of Ophthalmology, University of Minnesota. Seven patients (1.3%) with bilateral herpetic keratoconjunctivitis were identified.. In these seven patients, the age at the initial onset of corneal disease ranged from 7 weeks to 46 years, with a median of 18 years and a mean of 19.3 years. Five patients had systemic atopy, and two patients had severe ocular rosacea. Systemic immune disorders were noted in two patients. Recurrent blepharoconjunctivitis was noted in 8 eyes (57%), epithelial keratitis in 12 eyes (85.7%), stromal keratitis in 9 eyes (64.3%), necrotizing stromal keratitis in 5 eyes (35.7%), and progressive endotheliitis in 2 eyes (14.2%). Corneal complications included opacification, neovascularization, and corneal thinning or perforation. Penetrating keratoplasty was performed in 1 eye, in which endophthalmitis subsequently developed and which required enucleation. Four patients with continued use of oral antiviral prophylaxis (acyclovir 400 mg twice daily) since September 1999 showed significant decreases in recurrence. The average remission in these four patients was 1.7 years. The visual acuity at the last follow-up was 20/40 or worse in 6 eyes (42.8%).. In contrast to unilateral HSV keratitis, our patients with bilateral herpetic corneal infections had underlying atopy or immune deviations and evinced more protracted clinical courses. Long-term prophylactic antiviral treatment has reduced the incidence of recurrence in this group of patients.

Topics: Acyclovir; Adolescent; Adult; Age of Onset; Antiviral Agents; Child, Preschool; Corneal Neovascularization; Corneal Opacity; Corneal Stroma; Epithelium, Corneal; Female; Humans; Infant; Keratitis, Herpetic; Keratoconjunctivitis; Keratoplasty, Penetrating; Male; Middle Aged; Recurrence; Retrospective Studies; Visual Acuity

A 17-year-old youth presented with bilateral follicular conjunctivitis and nummular subepithelial corneal infiltrates. Failure of this to settle in an outpatient setting led to corneal scraping with microscopy and culturing for bacteria, fungi, Herpes simplex, adenovirus and Acanthamoeba as an inpatient. Polymerase chain reaction analysis of corneal cells was positive for adenovirus, and culture on live Escherichia coli-coated agar plates was positive for Acanthamoeba by phase contrast microscopy on day two. We conclude that Acanthomoeba infection can complicate adenoviral keratoconjunctivitis. This observation is in keeping with previously reported modes of infection by Acanthamoeba, whereby any epithelial breach seems to allow inoculation of the eye by this opportunistic organism.

Topics: Acanthamoeba; Acanthamoeba Keratitis; Acyclovir; Adenovirus Infections, Human; Adenoviruses, Human; Adolescent; Animals; Biguanides; Cyclopentolate; Drug Therapy, Combination; Eye Infections, Viral; Humans; Keratoconjunctivitis; Male; Prednisolone

The combination of acyclovir and ribavirin has been established to be more effective on experimental herpes simplex keratoconjunctivitis in rabbits than the treatment with individual drugs. The better therapeutic effect of the combination is proved by the decreased severity of the ocular infection and the reduction of the virus shedding in tear film, as well as by the diminished duration of the infection.

Topics: Acyclovir; Animals; Drug Evaluation, Preclinical; Drug Therapy, Combination; Keratitis, Herpetic; Keratoconjunctivitis; Rabbits; Ribavirin; Simplexvirus; Tears; Time Factors

Three observations of typical patients with persistent and recurrent nummuli after epidemic keratoconjunctivitis serve--pars pro toto--to demonstrate that longterm therapy with high-dosed topical steroid offers no therapeutic solution. This experience and other disadvantages of steroids in KCE (dry eyes) lead us to recommend not to apply topical steroids in KCE unless an adenovirus specific antiviral agent has become available for basic antiviral therapy.

Topics: Acyclovir; Adult; Cornea; Dose-Response Relationship, Drug; Female; Humans; Keratoconjunctivitis; Male; Ophthalmic Solutions; Prednisolone; Virus Diseases; Visual Acuity

Individuals with atopic dermatitis are particularly susceptible to herpes simplex viral infection and may develop dissemination (eczema herpeticum). Additionally, they may develop severe and bilateral herpetic ocular disease. The keratitis is commonly complicated by stromal scarring and slow epithelial healing despite topical antiviral therapy. We treated three patients who had herpetic keratoconjunctivitis associated with eczema herpeticum. In all three cases the keratitis resolved promptly (48 to 72 hours) without residual scarring after treatment with systemic acyclovir and topical trifluridine. The combined use of systemic acyclovir and topical trifluridine may be of similar value in treating all cases of atopic herpetic keratitis.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Kaposi Varicelliform Eruption; Keratitis, Dendritic; Keratoconjunctivitis; Male; Trifluridine

Topics: Acyclovir; Antiviral Agents; Encephalitis; Female; Herpes Genitalis; Herpes Simplex; Herpesviridae Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Keratoconjunctivitis; Male; Skin Diseases, Infectious; Vidarabine

Topics: Acute Disease; Acyclovir; Guanine; Herpes Simplex; Humans; Keratoconjunctivitis; Kidney Transplantation; Male; Middle Aged