Eye damage by herpes zoster virus
Last reviewed: 23.04.2024
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Eye damage by the herpes zoster virus, or Herpes Zoster. Symptoms are manifested by rashes on the skin of the forehead and a painful inflammation of all tissues of the anterior and sometimes posterior segments of the eye. The diagnosis is based on the characteristic appearance of the anterior part of the eye, when it is accompanied by the surrounding dermatitis along the first branch of the trigeminal nerve. Treatment is carried out using oral antiviral agents, mydriatica and local glucocorticoids.
Herpes zoster in the presence of lesions of the forehead skin affects the eyeball in 1/4 of the cases when the nasociliary nerves are involved (as indicated by the localization at the tip of the nose), and in 1/3 of cases it does not involve the tip of the nose.
[Symptoms of herpes of the eye
During an acute disease, in addition to the rash on the forehead, pronounced edema of the eyelids may be present; conjunctival, episcleral and pericorneal hyperemia; edema of the cornea, epithelial and stromal keratitis, uveitis, glaucoma and pain in the eye. Keratitis, accompanied by uveitis, can be severe, followed by scarring. Later consequences - glaucoma, cataract, chronic or recurrent uveitis, corneal scarring, neovascularization and hyperesthesia - occur frequently and reduce visual acuity.
Diagnosis of herpes simplex
Diagnosis is based on the presence of a typical rash on the forehead or a corresponding anamnesis and the presence of atrophic foci on the skin of the forehead. Herpetic lesions in this area, without eye involvement, suggest a high risk and determine the need for consultation of an ophthalmologist. Urgent sowing, immunological studies of the skin, PCR, or serial serological tests are performed when lesions are atypical and the diagnosis is unclear.
Treatment of herpes of the eyes
Early treatment with aciclovir 800 mg orally 5 times a day, famciclovir 500 mg daily or valciclovir 1 g orally 2 times a day for 7 days reduces eye complications. Unlike patients with herpes simplex virus, patients with keratitis or uveitis caused by the herpes zoster virus need local glucocorticoids (for example, 0.1% dexamethasone, which is first instilled every 2 hours, with an interval prolongation of 4 to 8 hours with symptomatic improvement ). The pupil should be kept dilated, using 1% atropine or 0.25% scopolamine 1 drop 2 times a day. It is necessary to monitor intraocular pressure and prescribe treatment if it is increased.
It remains a contradictory opinion to use a short course of high doses of glucocorticoids orally to prevent postherpetic neuralgia in patients over 60 years of age who have a good general health status.