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Herpetic keratouveitis and glaucoma

 

Infection of the eye caused by the virus herpes simplex (HSV), manifested in the form of recurrent unilateral blepharoconjunctivitis, epithelial and stromal keratitis and uveitis. The defeat of the eye can be seen in primary infection herpes zoster (chicken pox), but more often it occurs in herpes zoster ophthalmicus - reactivation of the virus herpes zoster ophthalmic branch in lesions V pair of cranial nerves in adults.

Uveitis caused by HSV virus and herpes zoster, is about 5% of all adults uveitis, usually develops on the background of herpetic keratitis. A characteristic feature of recurrent herpetic uveitis - an increase in intraocular pressure, which can lead to secondary glaucoma.

Epidemiology

Approximately 0.15% of the US population has a history of ocular manifestations of infection with HSV. In 2/3 of herpes zoster ophthalmicus infection of the eye was observed. Stromal keratitis and uveitis - the state, leading to the greatest disruption of visual function, in comparison with other forms of recurrent herpetic lesions eyes. Stromal keratitis, and uveitis developed in less than 10% of patients with primary infection eye virus herpes simplex. Uveitis and ocular hypertension in patients with herpes zoster ophthalmicus, may be associated with epithelial and stromal keratitis. The frequency of elevated intraocular pressure in patients with herpetic uveitis is 28-40%. The incidence of secondary glaucoma patients with uveitis caused by herpes simplex or herpes zoster, is 10-16%.

Reasons herpetic keratouveitis

Is the development of uveitis associated with herpes simplex keratitis, secondary to corneal lesion or associated with a viral invasion of the anterior choroidal currently unknown. Increased intraocular pressure in herpes simplex and herpes zoster uveitis occurs as a result of violations of the outflow of intraocular fluid as a result of trabekulita - inflammation trabeku-polar network. When uveitis caused by herpes zoster, developing ischemia associated with occlusive vasculitis, which can also lead to increased intraocular pressure. When herpetic uveitis anterior chamber of moisture was isolated herpes simplex, whose presence is likely to correlate with the development of ocular hypertension. Increased intraocular pressure in herpetic uveitis may be associated with prolonged use of glucocorticoids.

Symptoms of herpes keratouveitis

Patients suffering from herpetic uveitis, usually complain of redness of eyes, pain, photophobia and reduced visual acuity. Often in history there is evidence of recurrent keratitis. Patients suffering from herpes zoster uveitis typically older patients with herpes zoster ophthalmicus episode history. In rare cases, there is bilateral involvement HSV eye, a lesion herpes zoster eye is only one-sided.

Like other manifestations of herpetic eye disease, herpetic uveitis is recurrent and can be held against the backdrop of recurrent keratitis. During exacerbation of intraocular inflammation commonly observed increase in intraocular pressure, which at least permits uveitis may normalize or remain elevated. Approximately 12% of cases develop persistent increase in intraocular pressure, glaucoma requiring the appointment of therapy or surgery designed to improve filtration.

Ophthalmologic examination

At external examination reveals signs of iridocyclitis) lesions of the skin herpes zoster, conjunctival and ciliary injection. Corneal sensitivity to the affected eye is often reduced. The examination of the cornea in patients with herpetic keratouveitis reveal changes indicative of prior lesions or epithelial corneal stroma (epithelial lesions tree, tree haze active discoid or necrotizing stromal keratitis, neovascularization or scarring). When two forms of herpetic uveitis can detect diffuse nongranulomatous stellate or granulomatous pigmented precipitates in the cornea. In severe herpetic uveitis can detect rear adhesions and closing the anterior chamber angle. When uveitis caused by a virus herpes simplex, and herpes zoster, develops a characteristic atrophy of the iris. With the defeat of HSV atrophy occurs in the central department of the iris near the pupil, often spotted appearance, and for herpes zoster lesion atrophy of the iris has a segmental character and localized closer to the periphery. It is believed that with the defeat of herpes zoster cause atrophy of the iris is occlusive vasculitis in the stroma.

Differential diagnosis

Herpetic uveitis should be differentiated from heterochromic iridocyclitis Fuchs, glaukomotsikliticheskogo crisis and sarcoidosis. The presence of corneal hypoesthesia favors herpetic uveitis.

laboratory research

The diagnosis of herpetic uveitis is based on clinical data, usually does not require laboratory studies. In the absence of antibodies to HSV and varicella zoster virus diagnosed herpetic uveitis rule. Detection of viral DNA in intraocular fluid by polymerase chain reaction confirms the diagnosis of herpetic uveitis, but does not allow him to deliver.

Treatment of herpes keratouveitis

Uveitis associated with HSV or herpes zoster, assigned local glucocorticoid. When pain syndromes associated with ciliary spasm, may require the use of cycloplegic drugs. To reduce the risk of recurrence of epithelial keratitis antiviral drug should be appointed in addition to local glucocorticoids. It is shown that when taking into aciclovir reduces the incidence and severity of treelike keratitis, stromal keratitis and uveitis in patients with herpes zoster ophthalmicus. Antiglaucoma therapy should be carried out at elevated intraocular pressure. Sometimes it may require operation aimed at improving the filtration. It is believed that when herpetic uveitis argon laser trabeculoplasty is not effective.

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