Natural history of herpes zoster ophthalmicus: predictors of postherpetic neuralgia and ocular involvement.

Seventy-one patients presenting with acute herpes zoster ophthalmicus were followed up for six months for a prospective analysis of the natural history of the disease. Acute and chronic ocular complications, nasociliary nerve involvement, age, sex, rash, and pain were assessed, and the results are presented. Acute pain was measured by a visual analogue scale. Postherpetic neuralgia (PHN) was more likely in patients over 80 and in those who scored their pain highly at presentation. Duration of rash was longer in patients who developed PHN. No other associations between the parameters studied were found. Nasociliary nerve involvement was associated with subsequent ocular disease.     

Oral acyclovir for herpes zoster ophthalmicus.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.     

Central nervous system involvement after herpes zoster ophthalmicus

Purpose: To report central nervous system involvement after varicella zoster virus infection. Methods: We evaluated the frequency and type of neurological complications in patients initially presenting with ophthalmic herpes zoster at an ophthalmological department in a Danish university hospital, over a 7‐year period. Results: Of the 110 immunocompetent patients who presented with initial ophthalmic zoster, six (5.5%) suffered from neurological complications other than post‐herpetic neuralgia. Four experienced isolated cranial motor nerve palsies, one patient had meningitis with a favourable outcome and one patient had severe encephalitis with a poor clinical outcome. Conclusions: Central nervous system involvement after varicella zoster virus infection is an uncommon, but potentially life‐threatening, complication. Early recognition of neurological complications prompts acute, appropriate antiviral treatment.     

Varicella-zoster virus eye disease.

PURPOSE: To review the epidemiology, biology, systemic and ocular features, and treatment options for varicella zoster disease, including postherpetic neuralgia. METHODS: Literature search and review of author's experience with patients with varicella and herpes zoster ophthalmicus. RESULTS: In recent years there has been an increase in the knowledge about the biology, latency, and epidemiology of the varicella-zoster virus. The clinical features are correlated with the pathologic changes. The pathophysiologic mechanisms and treatment of postherpetic neuralgia are reviewed. Treatment options with antiviral therapy and corticosteroids are offered. Initial experience with the varicella vaccine is encouraging. CONCLUSIONS: The laboratory and clinical studies have enhanced our knowledge of the varicella-zoster virus and increased our ability to treat this infection and the aftermath. We are still far short of providing adequate therapy for patients who experience the severe forms of the disease.     

The management of ocular herpesvirus infections

The many treatment methods in current use for every known complaint only seem to aggravate the difficulty of treating ocular herpes simplex virus (HSV) infections, which are generally self-limited in the immunocompetent host. The cornea is already a somewhat immune-deficient tissue since its lack of blood vessels separates it partially from the host, and treatment with glucocorticoids, which are immuno-suppressive, increases the risk of damaging complications such as scarring, prolonged morbidity, bacterial or fungal superinfection, and the occasional corneal perforation. Accepted methods of treatment of specific lesions, are discussed, as are some methods that are not yet accepted, but which seem promising. Herpes zoster may result in scarring and significant loss of vision even without the use of glucocorticoids, the disease often manifesting itself in the already compromised host. The major complication is postherpetic neuralgia. None of the available treatment methods has been fully satisfactory, and every effort should be made to prevent eye lesions in patients with early infection of the ophthalmic branch of the trigeminal nerve. Stimulation of cellular immunity by various means appears to offer some new promise for control of the disease. Management of varicella, cytomegalovirus, and infectious mononucleosis are also discussed.     

Facial anesthetic blocks in the treatment of acute pain during ophthalmic zoster

BACKGROUND: Ophthalmic zoster is frequently accompanied by severe pain in the frontal and nasal divisions of the ophthalmic nerve. Treating this pain is often difficult, particularly in elderly patients, owing to iatrogenic effects and to interactions with the pre-existing diseases and treatments frequently present in this age group. The aim of our study was to consider the efficacy and toxicity of the frontal and nasal nerve blocks in the treatment of severe pain during acute ophthalmic zoster in the elderly. MATERIAL AND METHODS: A prospective study was conducted on 20 patients (mean age, 76 +/-7 years; range, 63-88) presenting with acute ophthalmic zoster with severe pain (less than 1 month since onset), which had resisted analgesic medication. All patients had a visual analogue score for pain (VAS) of 4 or more and received one or more anesthetic blocks of a compound of bupivacaine with adrenaline associated with clonidine at the frontal branch and sometimes the nasal branch levels of the ophthalmic nerve. Pain was measured daily by VAS for 5 days, and the blocks were repeated if the VAS was still 4 or higher. Patients were checked for local or systemic side effects. RESULTS: The number of anesthetic blocks per patient ranged from one to four (mean: 2.3 +/-0.7). All patients experienced less pain after the first injection. The mean preinjection VAS was 7.4 +/-1 and fell to 4.8 +/-1.0, 4.1 +/-1.1, 3.5 +/-1.0, 3.2 +/-0.6 and 2.8 +/-0.9 at day 1, day 2, day 3, day 4 and day 5, respectively (p<0.001). It was possible to reduce analgesic medication permanently in all patients. No local or systemic side effect was observed. CONCLUSION: Anesthetic blocks of the frontal and nasal branches, repeated if necessary, give fast and effective relief from the severe pain of acute ophthalmic zoster. They are fully tolerated and simple to administer, making them an excellent indication in the complementary treatment of the pain of hyperalgic acute zoster in the elderly.     

Herpes zoster optic neuritis

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.     

An unusual case of stabbing eye pain: a case report and review of trigeminal neuralgia.

BACKGROUND: Trigeminal neuralgia is a painful neurological disorder that affects one or more of the divisions of the trigeminal nerve. It is characterized by brief attacks of stabbing pain that can be excruciating. These attacks may be triggered by a light touch, shaving, or even eating. There has been much debate over the exact etiology of trigeminal neuralgia. One of the main theories is vascular compression of the trigeminal nerve as it leaves the brainstem. Another theory suggests that intracranial tumors--particularly those located in the posterior fossa--may be the cause. Trigeminal neuralgia is also associated with multiple sclerosis. CASE REPORT AND REVIEW: A 79-year-old man came to the eye clinic with signs and symptoms consistent with trigeminal neuralgia involving the ophthalmic and maxillary divisions of the nerve. A neurological evaluation confirmed the diagnosis, and proper medical treatment was subsequently implemented to relieve his pain. CONCLUSION: Patients who manifest symptoms consistent with trigeminal neuralgia should be referred for a neurological evaluation, including MRI. With the proper medical and/or surgical treatment, the quality of life of these patients can increase dramatically.     

Severe herpes zoster ophthalmicus in young African adults: a marker for HTLV-III seropositivity.

This report proves the relationship between herpes zoster ophthalmicus and seropositivity for HTLV-III in young and often apparently healthy African patients. The ophthalmologist should screen patients with herpes zoster ophthalmicus for antibodies against HTLV-III in areas where this virus is endemic or if the patient belongs to a known risk group. If the test is positive, the patient should be instructed about the infectious nature of his condition to prevent spread of this sexually transmitted disease. As the rate of corneal involvement and postherpetic neuralgia are very high in these patients, it would be worthwhile to ascertain whether routine use of acyclovir treatment in HTLV-III seropositive patients with herpes zoster has a beneficial effect on these complications.     

Cytarabine treatment of herpes zoster (author's transl)]

Systemic treatment of herpes zoster becomes possible by cytarabine. Complications of herpes zoster ophthalmicus such as relapsing corneal ulceration, perforation or scarring, secondary glaucoma, Argyll Robertson pupils, extraocular muscle palsies, and optic atrophy, as well as postherpetic neuralgia can be prevented by the use of this drug. For this reason the authors believe treatment with cytarabine to be the therapy of choice in herpes zoster.     

A pox upon your house

Herpes zoster ophthalmicus (HZO) is a common viral infectious disorder affecting the ophthalmic division of the trigeminal nerve. A small subset of HZO patients present with the ophthalmic symptoms, but without an accompanied rash, a condition described as Herpes zoster sine herpete. Although HZO is well known to be associated with other central nervous system abnormalities, encephalitis and cerebral infarction are atypical and uncommon. We report an unusual case of presumed unilateral Herpes zoster ophthalmicus sine herpete that presented with trigeminal pain and uveitis and then progressed to encephalitis and bilateral cerebral infarctions despite treatment with acyclovir and corticosteroids. The diagnosis of HZV was confirmed by polymerase chain reaction testing on the cerebrospinal fluid.     

Association of varicella zoster dermatitis with acute retinal necrosis syndrome

The authors report seven patients in whom the acute retinal necrosis (ARN) syndrome developed shortly after cutaneous varicella zoster infection. The length of time between the skin infection and ARN varied from 5 days to 3 months. Both eyes were affected in one of seven cases. The ophthalmic branch of cranial nerve V ipsilateral to an affected eye was involved by the zoster dermatitis in only two of the seven cases. The association lends further support to the proposal that herpes zoster virus is a major cause of ARN. A history of recent zoster dermatitis should be sought in patients with ARN.     

脉冲射频联合神经阻滞治疗眼睑带状疱疹神经痛

目的：观察脉冲射频联合神经阻滞治疗眼睑带状疱疹神经痛的疗效分析。

方法：2011-01/2014-08张家港市第一人民医院诊治的81例81眼眼睑带状疱疹患者,随机分为A、B、C三组。A组27例,全身静滴阿昔洛韦、地塞米松药物治疗。B组27例,在阿昔洛韦抗病毒药物治疗基础上,复方倍他米松等眶上神经阻滞。C组27例,在阿昔洛韦抗病毒药物治疗基础上,予脉冲射频联合神经阻滞治疗。比较三组治疗前,治疗后1、7、30、90d的疼痛视觉模拟评分(visual analogue scale,VAS)、临床治疗效果、并发症等情况。

结果：A组患者治疗前,治疗后1、7、30、90d VAS分别为8.2±1.5、7.3±1.6、6.5±1.4、6.1±1.1、5.9±0.7; B组患者治疗前,治疗后1、7、30、90d VAS分别为8.2±1.3、6.3±1.1、5.7±0.9、5.1±1.1、4.1±0.7; C组患者治疗前,治疗后1、7、30、90d VAS分别为8.1±1.5、2.1±0.7、2.2±0.8、2.9±0.7、2.7±0.8。C组患者在脉冲射频联合神经阻滞治疗后疼痛明显缓解,在1、3mo后疼痛评分虽略有恢复,但仍明显低于对照组。三组治疗后第1、7、30、90d VAS评分差异有统计学意义(F=10.320、5.207、2.364、2.805,均P<0.05)。C组患者除减轻疼痛外,无严重并发症,例如角膜知觉减退等,并且角膜炎及角膜溃疡发生的可能减少。

结论：脉冲射频联合神经阻滞治疗能迅速减轻疼痛,并减少该疾病引起的并发症,是眼睑带状疱疹神经痛的一种安全、有效的治疗方法。     

Diagnosis and therapy of herpes zoster ophthalmicus.

Studies in the basic and clinical sciences have yielded new information about the biology, infection, latency, and recurrence of the varicella-zoster virus. Contrast is made with the herpes simplex virus. The host-viral relationship is an extremely dynamic one with clinical disease being determined primarily by the host cellular immune system. The complications of herpes zoster ophthalmicus are related to multiple mechanisms including viral growth, vascular and neural damage, and the host-immune response to infection. There are several laboratory tests available for confirming the diagnosis or determining the immune status. Systemic acyclovir administered early in the course alleviates many of the symptoms of herpes zoster ophthalmicus. Acute and postherpetic neuralgia remain significant and enigmatic problems; an update of therapeutic options is offered. The role of corticosteroids in herpes zoster ophthalmicus is scrutinized along with the potential and uncertainties of a varicella-zoster virus vaccine.     

The ocular manifestations of herpes zoster,varicella, infectious mononucleosis,and cytomegalovirus disease

Herpes zoster, caused by varicella-zoster (V-Z) virus which also causes varicella (chickenpox), is usually a benign self-limited disease. However, when the ophthalmic division of the trigminal nerve is affected, the ocular disease (ophthalmic zoster), although also usually mild and self-limited, may have severe complications (corneal scarring, glaucoma, iris atrophy, posterior synechiae, scleritis, motor disturbances, optic neuritis, retinitis, anterior segment necrosis, and phthisis bulbi and severe postherpetic neuralgia). Varicella affects the eye rarely (except for the typical lid lesions), but associated conjunctival and corneal lesions, iridocyclitis, glaucoma, chorioretinitis, and optic nerve lesions have been described. Infectious mononucleosis may involve the eye either by direct involvement or from a remote focus such as the central nervous system. Ocular manifestations of cytomegalovirus disease is usually limited to the choroid and retina unless involvement of the developing embryo occurs prior to the development of the eye.     

Acute necrotizing retinitis following varicella zoster virus infection

As far as we know today, acute retinal necrosis is caused by infection with a virus of the herpes group. Reports are occasionally published of retinitis developing before or after herpes zoster dermatitis. The present paper reports the case of a patient who developed a retinitis of the right eye five years after a herpes zoster infection of the ophthalmic nerve. Studies and treatment of VZV retinitis and retinitis before or after zoster retinitis reported in the literature are summarized. The possible mechanisms of generalization (neurogenic or hematogenous) are analyzed.     

Oral acyclovir in the therapy of acute herpes zoster ophthalmicus. An interim report

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.     

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 conjunctival ulceration.

A 70 year old man acquired a herps zoster infection of the ophthalmic division of his right trigeminal nerve. During the course of the illness he developed the rare complication of a cojunctival ulcer. It is suggested that the ulceration may be the result of an ischemic ischemic vasculitis.     

HIV/AIDS患者眼部带状疱疹感染观察

目的 探讨HIV/AIDS患者眼部带状疱疹感染的病变特点、临床症状、治疗及预后.方法 回顾性分析205例(294只眼)HIV/AIDS患者的临床资料,包括视力、眼前节、眼底检查及外周血CD4+T淋巴细胞数,其中26例(26只眼)眼部带状疱疹感染患者早期给予更昔洛韦眼用凝胶点眼等药物治疗.结果 HIV/AIDS患者CD4+T淋巴细胞数多于200个/mm3者,带状疱疹感染临床症状相对较轻,眼部并发症少,病程短,约2～4周,愈合后视力无影响;CD4+T淋巴细胞数少于200个/mm3的AIDS患者,临床症状较重,眼部并发症较多,病程较长,约3～5周,神经痛可持续半年以上,视力无影响或不同程度的下降,2例用药不及时或使用疗效欠佳药物的患者,出现严重的眼部并发症,视力损害严重.结论 HIV/AIDS患者眼部带状疱疹感染,重在早期诊断,早期高效药物治疗.

Abstract：

Objective To investigate manifestations ,treatment and prognosis that herpes zoster in the eye area of HIV/AIDS patients.Methods Two hundred and five patients were recruited.Two hundred and ninety-four eyes underwent ophthalmologic examination that included vision acuity,anterior segment,fundus examination and the amount of the CD4+ T-lymphocyte.Ganciclovir ophthalmic gel and other medical treatment were adoptted to 26 herpes zoster virus patient Results The HIV/AIDS patients whose CD4+ T-lymphocyte was more than 200/mm3,the manifestations of the herpes zoster virus was not very serious,complications was less the course of disease lasted shorter(about 2-4 weeks),and there wouldn't be much influence in the vision acuity after recovery.While,the HIV/AIDS patients whose CD4+ T-lymphocyte was less than 200/mm3,the manifestations of the herpes zoster virus was more serious,complications was more,the course of disease lasted longer(about 3-5 weeks),the neuralgia could last more than half a year,and the vision acuity could be all the same as before or become worse in some degree.Two patients who didn't get medicine in time or the effect of medicine was not good enough,eventually got serious complication and the vision acuity became severe impaired.Conclusions The treatment in early stage and the efficient medicine really count a lot for the treatnent of HIV/AIDS patient with herpes zoster virus.