Uveitis in Herpes zoster ophthalmicus

Background : Herpes zoster ophthalmicus (HZO) is a common condition occurring mostly in healthy people. Approximately 50% of HZO patients develop ocular complications, with iridocyclitis occurring in about 43%. This study aimed to identify the clinical features of uveitis secondary to HZO. Method : A retrospective case study was performed of consecutive patients with HZO and secondary uveitis seen in the past 10 years at the Royal Victorian Eye and Ear hospital as well as those seen in the private clinics of two ocular immunology consultants. The information collected included the time relationship between onset of rash and uveitis, duration and treatment of the uveitis, and rate and nature of ocular complications. Results : Thirty‐four patients fulfilled the enrolment criteria. The age range was from 24 to 83 years with an average age of 62.5 years. Of these, 28 patients (82%) were immunocompetent and six patients (18%) had underlying immunosuppression from various causes. Twenty‐three patients had a uniphasic episode of uveitis and 11 patients (32%) had a chronic relapsing course of uveitis. The duration of the uveitis was variable, ranging from 1 week to 3 years, with 68% of episodes resolving within 2 months. Nineteen patients (56%) developed secondary glaucoma. Five of these patients (26%) required trabeculectomies to control their intraocular pressures. Three patients (9%) had bilateral ocular involvement and five patients (15%) had a reduction in final Snellen visual acuity of more than two lines. Conclusion : In this study, most patients were immunocompetent individuals. The course of the uveitis was generally uniphasic in nature and of a relatively short duration. There was a high incidence of secondary glaucoma with 15% of all patients requiring surgical intervention. The visual loss in the five patients was not directly related to the uveitis and secondary glaucoma but to other complications associated with HZO.     

Herpes zoster ophthalmicus presenting as orbital abscess along with superior orbital fissure syndrome: A case report

Orbital abscess and superior orbital fissure syndrome (SOFS) are rare manifestations of herpes zoster ophthalmicus. Herein, we report a case of orbital abscess along with SOFS in a 2.5-year-old-male child secondary to herpes zoster infection. He presented with a 5-day history of proptosis and ptosis of the right eye that had been preceded by vesicular eruptions on the right forehead and scalp. Computed tomography scan of the head and orbit showed orbital abscess and right cavernous sinus thrombosis. A diagnosis of orbital abscess with SOFS secondary to herpes infection was made. The condition subsequently improved following antiviral therapy, intravenous vancomycin and amikacin, and oral corticosteroids.     

带状疱疹性眼病与获得性免疫缺陷综合征

对 2 6例带状疱疹性眼病的特点及其与 AIDS病关系进行研究 ,以期对其并发症进行合理治疗 ,减轻视功能损害。患者年龄为2 3— 5 6岁 ,平均 3 3岁 ,男女各 13例。常见眼部并发症为角膜炎和前葡萄膜炎 ,其发生率分别为 69.2 3 %和 5 3 .85 %。其他并发症有继发青光眼 15 .3 8% ,白内障 11.5 4 % ,视神经炎 3 .84 % ,眼外肌麻痹 11.5 4 % ,疱疹后神经痛 3 0 .7%。 2 0例病人 ( 76.92 % )产生永久性视力损害 ,视力低于 0 .5者 14例 ( 5 3 .84 % )。 10例病人行血清 HIV检测均为阳性 ,其中 8例合并有 AIDS病相关全身表现。与 AIDS病有关的带状疱疹性眼病多发生在年轻患者 ,眼部并发症发生率高且重 ,治疗困难 ,视力损害明显 ,它不仅是AIDS病的常见并发症 ,也是最早期表现之一。     

Herpes zoster ophthalmicus

Introduction : Herpes zoster is a common disease which may cause serious ocular sequelae when it affects the trigeminal nerve. Although involvement of the nasociliary branch of the first division of the trigeminal nerve is well recognised to be associated with serious and direct ocular morbidity, the need for careful long‐term follow‐up of cases of frontal branch involvement is perhaps less well known. Methods : The pathogenesis, epidemiology, risk factors, clinical course and treatment of herpes zoster are discussed with emphasis on trigeminal nerve involvement. A case report is presented which illustrates the importance of continuing management when the frontal branch of the trigeminal nerve is affected. Discussion : Clinical guidelines are suggested for optometric management of these cases in cooperation with medical practitioners.     

A rare case of orbital apex syndrome with herpes zoster ophthalmicus in a human immunodeficiency virus-positive patient

We report a rare instance of favorable outcome in orbital apex syndrome secondary to herpes zoster ophthalmicus (HZO) in a human immunodeficiency virus (HIV)-positive patient. The patient complained of pain and decrease in vision in one eye (20/640) for 2 weeks accompanied with swelling, inability to open eye, and rashes around the periocular area and forehead. The presence of complete ophthalmoplegia, ptosis, relative afferent pupillary defect, and anterior uveitis with decreased corneal sensation prompted a diagnosis of HZO with orbital apex syndrome. The enzyme-linked immunosorbent assay test and a low CD4 count confirmed HIV. Highly active antiretroviral therapy (HAART), systemic acyclovir, and systemic steroids were started. Visual acuity and uveitis improved within 10 days. By the end of the fourth week, ocular motility also recovered and the final visual acuity was 20/25. We highlight the role of HAART, used in conjunction with systemic steroid and acyclovir therapy, in improving the outcome.     

Multifocal chorioretinal atrophy associated with Herpes zoster ophthalmicus

A 73‐year‐old woman developed multiple depigmented lesions in the fundus 4–6 months after an episode of acute Herpes zoster ophthalmicus. Post‐mortem examination of the globe 15 years after this acute episode confirmed multiple old chorioretinal scars probably due to vasculitis of the short posterior ciliary arteries and branches. Patchy old infarcts were also noted in the iris.     

Herpes zoster ophthalmicus

Herpes zoster ophthalmicus occurs worldwide, usually in healthy adults, but, increasingly in patients who are immunocompromised. After primary varicella infection (chickenpox), the virus lies dormant in the sensory ganglion until it becomes reactivated as zoster. Involvement of the ophthalmic branch of the trigeminal nerve is characterized early by corneal dysesthesia and dendritiform keratopathy, and these are self-limited. However, smoldering disease may cause pathological changes in the ocular structures through direct invasion of virus, secondary inflammation, and alterations of autoimmune mechanisms. Antiviral agents have demonstrated some success in resolving early signs and symptoms, but their role in preventing and treating late complications remains to be fully studied. Until a definitive antiviral agent is established, the benefits of steroid use in certain acute inflammatory processes outweigh its risk of reducing host immunity. Corneal complications of herpes zoster ophthalmicus sometimes require surgical intervention.     

Herpes zoster ophthalmicus: presenting as giant-cell arteritis

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.     

Orbital Apex Syndrome Secondary to Herpes Zoster Ophthalmicus

A 49-year-old woman who complained of lacrimation, foreign body sensation, and eyelid oedema presented to our outpatient clinic. External examination identified erythematous rash with vesicles on the left eyelid, dorsum of the nose, and forehead of the patient. She was diagnosed to have herpes zoster ophthalmicus (HZO), and was started on oral brivudine and topical acyclovir. On the third day of the treatment, visual acuity of left eye was reduced; left blepharoptosis and total ophthalmoplegia had developed. Orbital magnetic resonance imaging (MRI) showed enlargement of the extraocular muscles, and perineural enhancement of the optic nerve on that side. Oral brivudine was replaced with intravenous acyclovir, and oral corticosteroid was initiated. Complete resolution of proptosis and restriction of eye movements were achieved, and significant improvement of visual acuity was observed within a week.Orbital apex syndrome, a severe and rare complication of herpes zoster infection, can develop despite antiviral treatment. Rapid institution of appropriate therapy may provide complete recovery.     

眼带状疱疹与人免疫缺陷病毒(HIV)感染

目的：研究HIV感染人群中眼带状疱疹所致的眼脱并发症。方法：取1997年4月－1999年4月于赞比亚大学附属医院就诊的HIV抗体阳性的眼部带状疱疹患者192例,统计其眼部并发症及T辅助细胞的细胞受体4（CD4）计数。结果：CD4计数为5－480/mm^3,平均49／mm^3;192例眼带状疱疹患者中50例（26％）无或轻的眼部并发症;61例（32％）并发角膜基质炎;5例并发神经营养性角膜炎;50例（26％）并发角膜穿孔,10例患者行眼内容摘除术;120例（62％）并发虹膜睫状体炎;23例（13％）并发急性坏死性视网膜炎（ARN）;60例（31％）出现带状疱疹后神经疼。追踪观察中,101例（53％）视力恢复到0.5以上,而91例（47％）视力低于0.5。结论：眼部带状疱疹在HIV抗体阳性患者中可致严重的眼部并发症,并对视力造成很大的影响。     

老年人带状疱疹性眼病的特点

目的 :探讨老年人带状疱疹性眼病 (HZO)的临床特点及治疗转归。方法 :将 78例老年组与 72例非老年组HZO病例进行回顾性对比研究。结果 :两组共有的眼部病变为睑皮疹、结膜炎、角膜炎和虹膜睫状体炎 ,但老年组还有继发性青光眼、视神经炎和颅神经损害导致之上睑下垂、眼睑闭合不全、角膜知觉缺失和眼外肌麻痹等眼部并发症。老年组全病程平均治愈时间比非老年组长 ,(47 3± 3 7)天比 (18 5± 5 6 )天 ,P <0 0 1。结论 :老年人带状疱疹性眼病并发症多且严重 ,所需治愈时间长 (P <0 0 1) ,强调疗程中加强对全身性疾病综合治疗的重要性。     

非特异性炎症致眶尖综合征临床特征分析

目的 总结眶尖非特异炎症导致眶尖综合征患者的临床特征。设计 回顾性病例系列。研究对象 2016年6月至2019年5月北京同仁医院神经眼科及北京市普仁医院眼科眼眶非特异性炎症致眶尖综合征15例（16眼）。方法 回顾患者的临床症状、体征、化验及影像学检查、激素治疗效果及病情转归。主要指标 临床表现、眼眶及头颅CT、MRI表现。结果 15例中男性8例,平均年龄（53±16）岁。14/15例单眼发病。病灶均局限于眶尖区,7例同时累及海绵窦。首先出现患侧眼眶疼痛,相继出现眶尖综合征表现。眼眶MRI均显示眶尖部条片状不规则实性病灶,呈等T1WI、等T2WI信号,均匀强化。经全身或眼球局部糖皮质激素治疗后14眼（87.5%）眼痛完全消失,13眼（81.3%）上睑下垂改善,11眼（68.8%）眼球运动及复视症状改善。3个月后复查眼眶MRI病灶均缩小。仅一半患者治疗后视力提高,其余8眼（50.0%）视力无改善。随访过程中2例（12.5%）病变复发。结论 局限于眶尖的非特异炎症可导致严重的眶尖综合征。早期无眼红肿等炎症表现,眼球突出亦不明显,表现为眶周疼痛、眼球运动障碍,继而视力进行性损伤,易被误诊。临床表现和神经影像学是诊断主要依据。糖皮质激素治疗能有效改善眼球运动障碍和疼痛,但视力恢复困难,且病变有复发可能。（眼科,2021,30： 56-61）     

更昔洛韦联合He-Ne激光治疗眼带状疱疹40例疗效分析

目的 观察更昔洛韦联合He-Ne激光治疗眼带状疱疹的临床疗效.方法 将40例眼带状疱疹患者随机分成两组,治疗组20例给予更昔洛韦静脉输入,VitB1、VitB12服,合并角膜炎、虹膜睫状体炎者加用更昔洛韦滴眼液及散瞳药,同时联合He-Ne激光照射三叉神经相应部位;对照组20例单独给予上述药物治疗.观察患者水疱结痂,疼痛消失及眼并发症消失的时间.结果 治疗组水疱结痂及疼痛消失时间、眼并发症消失时间明显短于对照组.结论 联合He-Ne激光疗法治疗眼带状疱疹疗效明显优于单独药物治疗.     

眶尖综合征83例病因的临床分析

目的:阐述眶尖综合征的发病机制和临床特点,并探讨其病因鉴别流程.方法:1996-07/2006-07所收治确诊的眶尖综合征患者83例89眼对病因进行回顾总结,并结合文献进行分析.结果:占位性疾病29例(35%),外伤性疾病21例(25%),非特异性炎症疾病16例(19%),感染性疾病10例(12%),医源性疾病4例(5%),血管性疾病3例(4%).结论:眶尖综合征可由不同病因所致,讨论它们之间的鉴别诊断有利于提高对该病的诊断率.     

Aspergillus sphenoid sinusitis-induced orbital apex syndrome in HIV infection

Background: Orbital apex syndrome due to aspergillus sphenoid sinusitis is a rare condition. Human immunodeficiency virus (HIV) infection has recently been reported in aspergillus orbital abscess. To the authors' knowledge this is the first reported association of HIV with the orbital apex syndrome.
Methods: A 37-year-old HIV-infected man presented with headache, reduced vision and progressive ophthalmoplegia in the right eye. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed sphenoid sinusitis. Sphenoid sinus biopsy was performed.
Results: Light microscopy revealed infiltrative branching septate fungal hyphae. Fungal culture isolated Aspergillus fumigatus.
Conclusion: Atypical fungal infection such as Aspergillus fumigatus sphenoid sinusitis should be suspected in HIV-infected patients with orbital apex syndrome.     

Unusual case of orbital apex syndrome after chalazion excision

Orbital apex syndrome represents a heterogeneous group of disorders. It involves damage to the third, fourth and sixth nerves and the ophthalmic division of the fifth cranial nerve, and results in optic neuropathy. An 80‐year‐old man presented to our emergency clinic with left acute visual loss and three‐day history of ocular pain. His medical and ophthalmic history involved diagnosis of lung cancer and chalazion excision two weeks prior to presentation. There was total left ophthalmoplegia, vision was ‘no light perception’ and he had a relative afferent pupillary defect. An urgent computed tomography scan of the orbits showed sub‐periosteal abscess on the lateral wall of the orbit extending to the optic canal. The muscle cone was unaffected. The diagnosis was orbital apex syndrome. He underwent urgent drainage of the abscess and Staphylococcus aureus was identified with Gram stain. He was systemically administered intravenous antibiotics and steroids. His visual acuity and ophthalmoplegia improved rapidly 12 hours after surgery. Prompt diagnosis and treatment in cases of orbital apex syndrome, especially in immunocompromised patients, is important to prevent visual and life‐threatening complications.     

Successful delayed treatment of the traumatic orbital apex syndrome by nasal endoscopic decompression surgery

To report a patient with traumatic orbital apex syndrome, who fully recovered visual and extraocular function following surgery. A 34-year-old male presented with visual and extraocular function disorders in his right eye following traffic accident, who was referred to our hospital 5 weeks after accident. The patient underwent endoscopic optic nerve and orbital apex decompression with topical and systemic application of nerve growth factor and steroids after a failed trial of mega-dose intravenous corticosteroids. Visual acuity improved to 20/20 at 3 weeks after surgery, and the right eye globe moved in most directions at 1 year, which remained stable at 3 years. Surgical decompression should be considered even when symptoms have been present for over a month.     

Síndrome de ápex orbitario por herpes zoster ophthalmicus

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.     

Corneal complications from herpes zoster ophthalmicus

Of 94 patients with acute herpes zoster ophthalmicus who were seen during a six-year period, 61 had corneal involvement. The corneal complications in the order of chronological clinical occurrence were punctate epithelial keratitis in 51%, early pseudodendrites in 51%, anterior stromal infiltrates in 41%, sclerokeratitis in 1%, kerato-uveitis/endothelitis in 34%, serpiginous ulceration in 7%, delayed corneal mucous plaques in 13%, disciform keratitis in 10%, neurotrophic keratitis in 25%, and exposure keratitis in 11%. Some of the earlier lesions seemed to result from viral infection, whereas later lesions resulted from limbal vasculitis, an immunologic mechanism to soluble viral antigen, a delayed hypersensitivity reaction, or damage to nerves and tissues. An elucidation of the lesions awaits better viral and immunologic detection techniques and further histopathologic study. Modern topical and systemic antiviral therapy, corticosteroids, and surgery have a role in treatment.