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Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
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Herpes zoster ophthalmicus

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  • Corneal edema: Cornea has a ground-glass appearance. Associated with increast intraocular pressure (acute angle-closure glaucoma). Hyphema: Blood in the anterior chamber, usually precipitated by blunt trauma. Cataract: Sudden changes in blood glucose or electrolytes can alter hydration of the lens.
  • Patient fixes on object 15 feet away. Light held in front of one eye for 3-5 seconds, moved across to other eye for 3-5 second, then back to 1st eye. Normal response: constriction, followed by variable amounts of redilation. Eponym: Marcus Gunn pupil (named after 19th century Scottish ophthalmologist)
  • If greater than 2/3 of the nasal iris is in shadow, the chamber is probably shallow and the angle narrow.
  • Old Schiøtz tonometers: Patient supine, cornea anesthetized. Device indents cornea. Conversion made to IOC in mmHg. Electronic tonometers: Expensive and require daily calibration.
  • Associated with myopia Complaints of flashing lights, floaters, then visual loss
  • Associated with diseases that alter blood viscosity (polycythemia, sickle-cell, leukemia)
  • A subtype of optic neuritis. Inflammation of the optic disc (papilla). Optic neuritis can be associated with multiple sclerosis. Differential diagnosis of retrobulbar optic neuritis also includes compressive optic neuropathy (get a brain MRI).
  • Vascular supply to optic nerve interrupted (Giant cell arteritis, Trauma)
  • Transcript

    • 1. DEPARTMENT OF OPHTHALMOLOGY SINDH GOVT. QATAR HOSPITAL DR MARIAM KASHIF POST GRADUATE STUDENT(MCPS) DR JAMEEL AHMED BURNEY SUPERVISOR/HEAD OF DEPARTMENT
    • 2. CaseA 35 year old man presented with Fever - 4days Burning sensation on forehead and around left eye - 2 days Vesicular eruptions - 1 day Discharge (LE) - 1 day DV (LE) - 1 day
    • 3. History Low grade fever 4 days back associated with headache, tiredness and malaise. Pain and Burning sensation on left side of forehead and around left eye. 1 day back eruption of groups of vesicles on left side of forehead, left upper eyelid and nose associated with itching and pain. Redness and mucopurulent discharge from left eye along with decreased vision.
    • 4. Past History No long term illness, decreased appetite or weight loss. No drug history or known drug allergies. H/O chicken pox at the age of 10yrs.
    • 5. Family and Social History Unmarried, lives with parents and two siblings; all healthy. No addictions. Works in garment factory. Belongs to middle class family.
    • 6. Medical Exam Well oriented young man, in pain and concerned about his condition. Vitals: Blood pressure 120/70mmhg, pulse 80/min,temp 98 degree. CV: regular without murmur or gallop. Chest: clear. Abdomen: no significant finding.
    • 7. Ocular Exam Visual Acuity 6/6 RE 6/12 LE External Inspection :erythamatous skin, groups of flesh colored vesicles on left side of forehead, left upper eyelid, along lid margin, side and tip of the nose. (Hutchinsons Sign) Bilateral Ocular Motility normal Pupillary reactions normal
    • 8. Slit Lamp Examination RIGHT EYE LEFT EYEConjunctiva Normal HyperemiaCornea Clear Ulcer (Dendritic in Sensation pattern normal Fluorescine +ve) Sensation reducedAnterior Normal NormalchamberLens Clear ClearFundus Normal Normal
    • 9. Differential DiagnosisOCULAR SKINHerpes simplex keratitis Drug allergyHerpes zoster ophthalmicus Contact dermatitis Insect bite
    • 10. DiagnosisHERPES ZOSTER OPHTHALMICUS History Vesicles (Hutchinson’s Sign) Dendritic ulcer
    • 11. Varicella zoster virus Double stranded DNA virus Alphaherpesvirinae
    • 12. Overview VARICELLA ZOSTER VIRUSChicken pox dorsal root ganglia reactivation shingles single dermatome
    • 13. Risk Factors 90% susceptible after primary infection Old age Immunosupression Malignancy Severe illness
    • 14. Herpes Zoster Ophthalmicus Involvement of first Division (Ophthalmic) of Trigeminal nerve
    • 15. Symptoms Prodromal (fever ,fatigue ,malaise, headache) Burning pain (forehead ,eyelid ,nose) Vesicles Red Eye Watering/Discharge Photophobia Decreased vision
    • 16. Signs (Ex.Ocular) Hutchinson’s Sign( vesicles on forehead, upper eyelid, side & tip of nose)
    • 17. Hutchinsons sign
    • 18. Signs (ocular) Conjunctivitis(Hyperemia, discharge)
    • 19. Signs (ocular) Keratitis Dendritic corneal ulcer ( Fine branching pattern)
    • 20. Dendritic ulcer
    • 21. Signs (ocular) Staining Fluorescein Rose Bengal
    • 22. Signs (ocular) Corneal epithelial defects and ulcers
    • 23. Signs (ocular) Anterior Uveitis (affects a third of patients) Red eye Cells, flare Posterior synachiae Keratic precipetates (KPs) Posterior Synachiae
    • 24. Anterior Uveitis KPs
    • 25. Signs (ocular) Episcleritis Scleritis Stromal keratitis Disciform keratitis
    • 26. Complications Post herpetic neuralgia : pain that remains for more than 1 month after rash has healed 75% cases (esp. over 70yrs) aggravated by minor stimuli (touch ,heat) Cranial nerve palsies Third (most common) Fourth & sixth Optic neuritis Encephlitis Rare Cranial arteritis Guillain-Barre syndrome
    • 27. Ocular complications Eyelid scarring Raised IOP (steroid induced) Neurotrophic keratitis Chronic scleritis Lipid degeneration (cornea)
    • 28. TreatmentSystemic :Within 72hrsAcyclovir 800mg 5 times dailyFamciclovir 500mg TID
    • 29. TreatmentLocal: Acyclovir skin ointment (rash) Topical Acyclovir Topical antibiotics (Chloramphenicol) Topical steroids (uveitis)
    • 30. Treatment of ComplicationsPost herpetic neuralgia Cold compress Local CAPSAICIN oint (QID) / LIDOCAINE oint Pain killers Oral Tricyclic antidepressantsNo Post herpetic neuralgia
    • 31. Message A common and treatable viral infection. Patient education/Counseling. Post herpetic neuralgia is extremely painful condition. Can transmit chicken pox.

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