DEPARTMENT OF OPHTHALMOLOGY SINDH GOVT. QATAR HOSPITAL DR MARIAM KASHIF POST GRADUATE STUDENT(MCPS) DR JAMEEL AHMED BURNEY SUPERVISOR/HEAD OF DEPARTMENT
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
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.
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.
Family and Social History Unmarried, lives with parents and two siblings; all healthy. No addictions. Works in garment factory. Belongs to middle class family.
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.
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
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
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