acyclovir and Scleritis

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

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

Rituximab is a widely used biologic agent, which has shown favourable results in the treatment of vasculitis. But immunosuppressive treatment also bears the risk of severe complications.. A patient with rheumatoid arthritis, progressive scleromalacia, and acute retinal necrosis on therapy with rituximab is reported.. For the first time, a correlation between rituximab and acute retinal necrosis in a patient with progressive rheumatoid scleromalacia is shown.. Although rituximab is a promising biologic agent for the treatment of autoimmune diseases, it bears the risk of reactivation of viral infections, including the onset of acute retinal necrosis.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Arthritis, Rheumatoid; Drug Therapy, Combination; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunosuppressive Agents; Middle Aged; Prednisone; Retinal Necrosis Syndrome, Acute; Rituximab; Scleritis; Virus Activation

We report the case of an immunocompetent male who presented with a limbal-adjacent scleritis and interstitial keratitis in the left eye. A few days later a new dendritiform ulcer in his right eye and bilateral progressive worsening with granulomatous uveitis in both eyes were observed. A thorough review of systems revealed positive serum IgM titles for herpes simplex virus.. In the context of a bilateral keratouveitis refractory to conventional treatment it is mandatory to rule out the herpetic origin based on the different forms of clinical presentation of this virus.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Corneal Opacity; Corneal Ulcer; Granuloma; Humans; Immunocompetence; Immunoglobulin M; Keratitis, Herpetic; Male; Scleritis; Simplexvirus; Uveitis; Virus Activation

To report on the various clinical presentations, etiological diagnosis, prognosis and treatment of patients with scleritis evaluated at a tertiary care eye center.. Retrospective, monocentric study on a series of 32 patients in a tertiary center.. The mean age of included patients with scleritis was 46.8 years (range, 22 to 77 years). Nineteen patients were women and 13 were men. Twenty-six patients (81%) had anterior scleritis (15 nodular, 8 diffuse and 3 necrotizing), six (19%) had posterior scleritis. Unilateral inflammation was present in 24 patients (75%). Twelve out of the 32 patients (37.5%) had an underlying systemic disease: granulomatosis with polyangiitis (n=3), Behçet's disease (n=2), unspecified inflammatory arthritis (n=2), psoriatic arthritis (n=1), ankylosing spondylitis (n=1), sarcoidosis (n=1), Cogan's syndrome (n=1) and ulcerative colitis (n=1). Six patients (18.8%) were suspected of having infectious disease with herpes virus: clinical context and positive treatment response with oral valacyclovir. Systemic agents and topical agents were required in 28 patients (87.5%). The first line therapy was mainly oral non-steroidal anti-inflammatory drugs in 15 patients (47%) and oral corticosteroids in 8 (25%). Immunosuppressive drugs were required in 6 patients. The mean follow-up was 16.3 months. Six patients (19%) had a decrease in visual acuity.. The number of systemic disease in our series is similar to the main series in the literature. Treatment with valaciclovir might be effective in patients with suspected herpes simplex scleritis.

Topics: Academic Medical Centers; Acyclovir; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Scleritis; Treatment Outcome; Valacyclovir; Valine

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

To report recurrent conjunctivitis and scleritis secondary to coexistent conjunctival pemiphigus vulgaris and cryptic herpes simplex infection.. Case report.. Retrospective review.. A 54-year-old woman presented with recurrent left eye irritation and redness. Four years earlier, she was diagnosed (biopsy) with cutaneous pemphigus vulgaris requiring immunomodulatory therapies. She was receiving oral acyclovir for recurrent genital herpes and intravenous immunoglobulin for pemphigus. Examination revealed unilateral necrotizing scleritis and conjunctivitis. Immunohistochemical staining of biopsies demonstrated conjunctival pemphigus and herpes in conjunctiva and sclera. Valacyclovir therapy brought resolution.. Cryptic ocular herpes may confound matters in someone with an autoimmune disease thought to be the sole source of ocular inflammation. Immunohistochemical analysis can resolve the mystery.

Topics: Acyclovir; Antiviral Agents; Conjunctival Diseases; Conjunctivitis; Female; Herpes Simplex; Humans; Immunoglobulins, Intravenous; Medical Records; Middle Aged; Necrosis; Pemphigus; Recurrence; Retrospective Studies; Scleritis; Valacyclovir; Valine

To characterize in detail persistent and recalcitrant infectious scleritis resulting from herpes simplex virus (HSV).. Retrospective and interventional clinical and immunopathologic case series.. Nine patients with chronic scleral redness, edema, and pain refractory to conventional therapy underwent a scleroconjunctival biopsy for routine histopathologic evaluation and definitive immunodiagnosis for the presence of HSV. Immunofluorescent probing for HSV was performed on the patient specimens. Negative controls for HSV included elimination of anti-HSV and anti-varicella zoster virus antibody in the probing process and the use of normal human conjunctiva and sclera as substrates. Response to therapy with acyclovir was monitored and recorded.. The average age of the affected patients was 50.2 years, and the average duration of symptoms before tissue diagnosis of herpetic scleritis was 3.2 years (median, 4 years). Three histopathologic patterns were discovered: granulomatous inflammation (2 cases), plasma cell-rich pyogenic granuloma-like pattern (1 case), and reactive fibroinflammatory pattern (6 cases). Herpes antigen was demonstrated uniformly by immunofluorescence in a perivascular distribution and less commonly in the interstitium. Varicella zoster virus was not detected, and all controls for nonspecific antibody reagent binding to tissue showed negative results. Acyclovir caused a dramatic improvement in the chronic or recurrent ocular inflammation in all instances, with an average duration of improvement of inflammation of 15.3 months.. Unrecognized HSV infection can cause longstanding scleritis. Histopathologic features of HSV scleritis are varied and nonspecific; immunofluorescent demonstration of HSV protein can make a definitive diagnosis. Prolonged administration of acyclovir is required for effective therapy.

Topics: Acyclovir; Adult; Aged; Antigens, Viral; Antiviral Agents; Chronic Disease; Eye Infections, Viral; Female; Fluorescent Antibody Technique, Indirect; Herpes Simplex; Humans; Male; Middle Aged; Retrospective Studies; Scleritis; Simplexvirus; Time Factors

To report ocular manifestations associated with chikungunya.. Retrospective, nonrandomized, observational case series.. Nine chikungunya patients with ocular involvement.. All patients with chikungunya infection presenting with ocular complaints from September 2006 to October 2006 were included in the study. The infection was confirmed by demonstration of chikungunya immunoglobulin M antibody in sera of all patients. All patients underwent an ophthalmic examination including fundus photography, fundus fluorescein angiography, confocal microscopy of keratic precipitates, and optical coherence tomography. Positive ocular changes were recorded and tabulated.. Characteristics, frequency, and locations of ocular lesions found in the participants.. There were 9 patients with ocular lesions; 1 had nodular episcleritis, 5 presented with acute iridocyclitis, and 3 had retinitis. Four to 12 weeks before the development of ocular manifestations, all of these patients had fever. Although there were no specific changes of iridocyclitis that were diagnostic of the fever, the retinal changes were consistent with viral retinitis. All patients recovered from the infection with relatively good vision.. It appears that iridocyclitis and retinitis are the most common ocular manifestations associated with chikungunya, with a typically benign clinical course. Less frequent ocular lesions include episcleritis. All the patients responded well to the treatment with preservation of good vision. To the best of our knowledge, similar ocular manifestations associated with chikungunya infection have not been reported. In the differential diagnosis of iridocyclitis and retinitis with features suggestive of a viral infection, the entity of chikungunya-associated ocular changes should be considered in the regions affected by the epidemic.

Topics: Acyclovir; Adult; Aged; Alphavirus Infections; Antibodies, Viral; Antiviral Agents; Chikungunya virus; Diclofenac; Drug Therapy, Combination; Eye Infections, Viral; Female; Fluorescein Angiography; Humans; Immunoglobulin M; Iridocyclitis; Male; Microscopy, Confocal; Middle Aged; Prednisolone; Retinitis; Retrospective Studies; Scleritis; Tomography, Optical Coherence; Visual Acuity

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 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

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

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