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Herpes Zoster Ophthalmicus

Herpes zoster ophthalmicus  HZO, also known as Ocular Shingles, is a painful dermatomal rash around the eye region and forehead caused by the reactivation of the Varicella Zoster Virus (VZV). It affects the trigeminal nerve of the ophthalmic division and eventually spreads to the other structures of the eye. The first division of the trigeminal nerve is the most common site for the development of acute herpes zoster.


Varicella-zoster virus manifests at two different stages in humans. At primary level the virus causes chicken pox after which it remains dormant for several years and reappears as herpes zoster later in the patient’s life. Aging, poor nutrition and low immunity are some of the risk factors that leads to the outbreak of Herpes zoster ophthalmic us (HZO).


 

Symptoms

HZO begins with flu-like symptoms including fever, Myalgia, and malaise for nearly a week. Typically, patients then develop tingling sensation and painful rash on the forehead and ocular symptoms such as eyelid edema; conjunctival, episcleral and circumcorneal conjunctival hyperemia; corneal edema and light sensitivity. All these symptoms are unilateral - occurring on one side of the face. 


 

Diagnosis

Herpes zoster ophthalmicus (HZO) is diagnosed clinically by mere observation of the symptoms. During a clinical visit, the ophthalmologist conducts a detailed examination of  visual acuity, visual fields, extra ocular movements, pupillary response, corneal function, Intraocular Pressure and anterior chamber. Doctor also makes a note of past history of chicken pox infection along with clinical examination. Viral culture, direct immunofluorescence assay, or Polymerase chain reaction (PCR) may also be used to confirm the diagnosis. Any signs of Hutchinson disease strongly indicates ocular complications such as inflammation and corneal denervation and forms the basis for diagnosis of herpes zoster ophthalmicus.


 

Treatment

Herpes zoster ophthalmicus is a medical emergency and should be treated promptly to avoid vision loss. The disease leads to many ocular conditions such as dermatitis, corneal pseudo-dendrites, uveitis, retinitis, and in rare cases it also causes cranial nerve palsies. Oral anti viral medicines like Acyclovir and Famcyclovir play a major role in treating herpes zoster ophthalmicus. Atropine eye drops are also prescribed to alleviate the painful symptoms. In case keratitis develops, Corticosteroid drops along with Cycloplegics (eye drops to induce ciliary muscle paralysis) may also be considered.


 

Sarcoidosis

Sarcoidosis is a rare autoimmune disease where the body's own tissues are attacked leading to small lumps (granulomas). It can affect the lungs, heart, brain, skin and nervous system, eyes and other organs. Sarcoidosis usually affects the lungs or lymph nodes. The skin, liver and eyes are also often affected. Granulomas are small scars on the affected organs. These granulomas are very small and are visible only under a microscope. Tiny granulomas clump together and cause a big scar. Scarring affects the normal functioning of the affected organ. This disease has a tendency to affect more than one organ at a time. In its active phase, sarcoidosis manifests as scar tissues on the affected organs. When sarcoidosis is in a non-active phase, the granulomas do not grow. Sarcoidosis cases are more pronounced among African -Americans. The highest occurrences of Sarcoidosis are noticed among Scandinavians and red-haired Irish women. Sarcoidosis was originally called Hutchinson's disease or Boeck's disease.


Sarcoidosis is treated according to its extent and severity. Symptoms of sarcoidosis include arthritis in the ankles and disturbed heart rhythms. In most cases of mild sarcoidosis, the inflammation is resolved on its own. In severe cases, the damage is permanent. When vital organs are affected by sarcoidosis, it results in death. In many cases, Sarcoidosis does not manifest in any symptoms. A patient suffering from sarcoidosis notices skin and lung problems, weight loss and fatigue. There may be eye problems and arthritis. Patients suffering from this condition may notice shortness of breath and prolonged cough. Skin lesions may appear. Sarcoidosis is noticed during chest x-rays, blood tests and pulmonary function tests. Biopsies of skin lesions or lymph nodes can help in diagnosing sarcoidosis. Oral steroids such as prednisone or prednisolone are used in the treatment of sarcoidosis. Topical creams or ointments are used to treat sarcoidosis of the skin or eyes.


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Bibliography / Reference

Collection of Pages - Last revised Date: December 9, 2019