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DEPARTMENT OF OPHTHALMOLOGY  SINDH GOVT. QATAR HOSPITAL       DR MARIAM KASHIF    POST GRADUATE STUDENT(MCPS)   DR JAMEEL ...
CaseA 35 year old man presented with Fever                  - 4days Burning sensation on forehead  and around left eye  ...
History Low grade fever 4 days back associated  with headache, tiredness and malaise. Pain and Burning sensation on left...
Past History No long term  illness, decreased appetite  or weight loss. No drug history or known drug allergies. H/O ch...
Family and Social History Unmarried, lives with parents and two  siblings; all healthy. No addictions. Works in garment...
Medical Exam Well oriented young man, in pain and  concerned about his condition. Vitals: Blood pressure 120/70mmhg, pul...
Ocular Exam   Visual Acuity 6/6 RE 6/12 LE   External Inspection :erythamatous skin, groups    of flesh colored vesicles...
Slit Lamp Examination              RIGHT EYE   LEFT EYEConjunctiva   Normal      HyperemiaCornea        Clear       Ulcer ...
Differential DiagnosisOCULAR                            SKINHerpes simplex keratitis     Drug allergyHerpes zoster ophthal...
DiagnosisHERPES ZOSTER OPHTHALMICUS   History   Vesicles (Hutchinson’s Sign)   Dendritic ulcer
Varicella zoster virus   Double stranded DNA virus   Alphaherpesvirinae
Overview              VARICELLA ZOSTER VIRUSChicken pox   dorsal root ganglia   reactivation      shingles                ...
Risk Factors 90% susceptible after primary infection Old age Immunosupression Malignancy Severe illness
Herpes Zoster Ophthalmicus Involvement of first Division (Ophthalmic) of Trigeminal nerve
Symptoms   Prodromal (fever ,fatigue ,malaise, headache)   Burning pain (forehead ,eyelid ,nose)   Vesicles   Red Eye...
Signs (Ex.Ocular) Hutchinson’s Sign( vesicles on forehead, upper eyelid, side &  tip of nose)
Hutchinsons sign
Signs (ocular) Conjunctivitis(Hyperemia, discharge)
Signs (ocular)   Keratitis   Dendritic corneal ulcer ( Fine branching pattern)
Dendritic ulcer
Signs (ocular) Staining    Fluorescein                        Rose Bengal
Signs (ocular)   Corneal epithelial defects and ulcers
Signs (ocular)   Anterior Uveitis (affects a third of patients)   Red eye   Cells, flare   Posterior synachiae   Kera...
Anterior Uveitis   KPs
Signs (ocular) Episcleritis Scleritis Stromal keratitis Disciform keratitis
Complications   Post herpetic neuralgia : pain that remains for more than    1 month after rash has healed    75% cases (...
Ocular complications Eyelid scarring Raised IOP (steroid induced) Neurotrophic keratitis Chronic scleritis Lipid dege...
TreatmentSystemic :Within 72hrsAcyclovir 800mg 5 times dailyFamciclovir 500mg TID
TreatmentLocal: Acyclovir skin ointment (rash) Topical Acyclovir Topical antibiotics (Chloramphenicol) Topical steroid...
Treatment of ComplicationsPost herpetic neuralgia   Cold compress   Local CAPSAICIN oint (QID) /    LIDOCAINE oint   Pa...
Message A common and treatable viral infection. Patient education/Counseling. Post herpetic neuralgia is extremely  pai...
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus
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Herpes zoster ophthalmicus

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Herpes zoster ophthalmicus

  1. 1. DEPARTMENT OF OPHTHALMOLOGY SINDH GOVT. QATAR HOSPITAL DR MARIAM KASHIF POST GRADUATE STUDENT(MCPS) DR JAMEEL AHMED BURNEY SUPERVISOR/HEAD OF DEPARTMENT
  2. 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. 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. 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. 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. 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. 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. 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. 9. Differential DiagnosisOCULAR SKINHerpes simplex keratitis Drug allergyHerpes zoster ophthalmicus Contact dermatitis Insect bite
  10. 10. DiagnosisHERPES ZOSTER OPHTHALMICUS History Vesicles (Hutchinson’s Sign) Dendritic ulcer
  11. 11. Varicella zoster virus Double stranded DNA virus Alphaherpesvirinae
  12. 12. Overview VARICELLA ZOSTER VIRUSChicken pox dorsal root ganglia reactivation shingles single dermatome
  13. 13. Risk Factors 90% susceptible after primary infection Old age Immunosupression Malignancy Severe illness
  14. 14. Herpes Zoster Ophthalmicus Involvement of first Division (Ophthalmic) of Trigeminal nerve
  15. 15. Symptoms Prodromal (fever ,fatigue ,malaise, headache) Burning pain (forehead ,eyelid ,nose) Vesicles Red Eye Watering/Discharge Photophobia Decreased vision
  16. 16. Signs (Ex.Ocular) Hutchinson’s Sign( vesicles on forehead, upper eyelid, side & tip of nose)
  17. 17. Hutchinsons sign
  18. 18. Signs (ocular) Conjunctivitis(Hyperemia, discharge)
  19. 19. Signs (ocular) Keratitis Dendritic corneal ulcer ( Fine branching pattern)
  20. 20. Dendritic ulcer
  21. 21. Signs (ocular) Staining Fluorescein Rose Bengal
  22. 22. Signs (ocular) Corneal epithelial defects and ulcers
  23. 23. Signs (ocular) Anterior Uveitis (affects a third of patients) Red eye Cells, flare Posterior synachiae Keratic precipetates (KPs) Posterior Synachiae
  24. 24. Anterior Uveitis KPs
  25. 25. Signs (ocular) Episcleritis Scleritis Stromal keratitis Disciform keratitis
  26. 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. 27. Ocular complications Eyelid scarring Raised IOP (steroid induced) Neurotrophic keratitis Chronic scleritis Lipid degeneration (cornea)
  28. 28. TreatmentSystemic :Within 72hrsAcyclovir 800mg 5 times dailyFamciclovir 500mg TID
  29. 29. TreatmentLocal: Acyclovir skin ointment (rash) Topical Acyclovir Topical antibiotics (Chloramphenicol) Topical steroids (uveitis)
  30. 30. Treatment of ComplicationsPost herpetic neuralgia Cold compress Local CAPSAICIN oint (QID) / LIDOCAINE oint Pain killers Oral Tricyclic antidepressantsNo Post herpetic neuralgia
  31. 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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