1. 1. Prodromal phase:
◦ Sudden onset of illness with fever, malaise, neuralgic pain along the course
of affected nerve.
◦ Symptoms: Vary from superficial itching, tingling sensation to a severe
boring or launching pain
◦ Distribution of pain is so characteristic that suspicion of the disease arouses
before vesicles appear.
2. Eruptive phase: Skin lesions appear 3-4 days of the onset Of disease
◦ They occur in the following sequence-
Maculopapular rashes, characterised by erythematous areas occur
Vesicle formation then begins in 24 hrs.
2. Pustule formation follows further
Crusting ulcers then formed due to bursting of the pustules and
vesicles
Depigmented pitted scars and areas of residual skin destruction left
3. Phase of ocular lesions: Appear at the subsidence of skin lesions
and present as a combination of the following lesions
◦ Conjunctivitis- One of the most common lesion. May occur as
mucopurulent conjunctivitis, acute follicular conjunctivitis or severe
necrotising membranous Inflammation.
◦ Zoster keratitis: occurs in 40 percent of all patients. May occur in several
forms like epithelial keratitis, nummular keratitis, disciform or keratiuveitis
with endothelitis.
◦ Other common lesions include episcleritis and scleritis, iridocyclitis, acute
retinal necrosis and secondary glaucoma.
3. Chronic stage lesions: These include
◦ Post herpetic neuralgia- refers to persistence of pain even after subsidence
of Eruptive phase of zoster.
◦ Lid lesions- occur as sequelae of scarring include ptosis, trichiasis,
entropion and notching
◦ Conjunctival lesions- include chronic mucous secreting conjunctivitis
◦ Corneal lesions
◦ Scleritis and uveitis
Relapsing stage lesions:
◦ May occur after few years and include nummular keratitis, mucous
plaque keratitis, scleritis and glaucoma.
4. Treatment
◦ The following treatment regime may be followed:
1. Systemic therapy for herpes zoster
A. Oral antiviral drugs: Acyclovir (800 mg 5 times a day for
10 days), Valaciclovir ( 1000mg TDS for 10 days), Famciclovir (
500 mg TDS for 7days)
B. Analgesics: Combination of mephenamic acid and
paracetamol or pentazoin are given.
C. Systemic steroids: Used in combination with antiviral drugs
in In cases developing complications.
D. Cimetidine: 300mg QID for 2-3 weeks
E. Amitriptyline: used to relieve depression in acute phase.
5. ◦ Local therapy for ocular lesion_
1 For zoster keratitis, iridocyclitis and Scleritis - Topical steroids eye drops 4
times a day .
Cycloplegics such as cyclopentolate eyedrops BD or atropine eye ointment OD.
2 To prevent secondary infection s topical antibiotic used.
◦ Treatment of prostherpetic neuralgia –
Topical lidocaine in the form of 5 percent gel or skin patches is useful.
◦ Surgical treatment-
1 Lateral tarsorrhaphy 2 Amniotic membrane transplantation
3 Tissue adhesion 4 Keratoplasty
