This document discusses viruses, specifically herpes simplex virus (HSV). It provides details on HSV including that it is a double stranded DNA virus that can establish latent infections in sensory ganglia. It then describes the various clinical manifestations of HSV infection, including epithelial keratitis, stromal keratitis, iridocyclitis, and neurotrophic keratitis. The document outlines treatments for different manifestations of HSV infection, noting that topical antivirals and corticosteroids are commonly used depending on the specific presentation. It also summarizes findings from the Herpes Eye Disease Study trials regarding optimal treatment approaches.
This presentation describes the background of the cornea and the corneal diseases in general, also it describes in detailed manner how to manage the corneal ulcer with its different causes
Vitreous hemorrhage is the extravasation, or leakage, of blood into the areas in and around the vitreous humor of the eye.[1] The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye. A variety of conditions can result in blood leaking into the vitreous humor, which can cause impaired vision, floaters, and photopsia.
It's an indepth presentation by Dr. Shah-Noor Hassan.
Uveitis is an interesting disease of the with such a varied and diverse pathogenesis, various systemic causes and Dangerous complications in relation to the eye which makes it difficult and challenging to treat in a proper way. I hope this share will help.
This presentation describes the background of the cornea and the corneal diseases in general, also it describes in detailed manner how to manage the corneal ulcer with its different causes
Vitreous hemorrhage is the extravasation, or leakage, of blood into the areas in and around the vitreous humor of the eye.[1] The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye. A variety of conditions can result in blood leaking into the vitreous humor, which can cause impaired vision, floaters, and photopsia.
It's an indepth presentation by Dr. Shah-Noor Hassan.
Uveitis is an interesting disease of the with such a varied and diverse pathogenesis, various systemic causes and Dangerous complications in relation to the eye which makes it difficult and challenging to treat in a proper way. I hope this share will help.
OCULAR VIRAL ILLNESSES with different ocular manifestationsBARNABASMUGABI
it entails a description of the ocular manifestations of various viral infections and their management aswell as their complications and how to go about the complications
This presentation describes all clinical aspects of infectious corneal ulcers
You can watch the illustrated presentation in this link :
https://www.youtube.com/watch?v=okWDPG3C34g&list=PLZ_mM13I_TrhwqZuGjB6M9Z3n7MntrURd
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
2. Viruses-
Viruses are small (10 – 400 nm in diameter)
infectious units with a single- or double-stranded
nucleic acid genome
A protein capsid shell, with or without an external
lipid envelope
4. Herpes Simplex Virus
Herpes virus infections have been prevalent as early as
ancient Greek times.
Hippocrates is known to have described the cutaneous
spreading of herpes simplex lesions
Greek word "herpes" to mean "to creep or crawl"
5. Enveloped linear double stranded DNA viruses.
Genome - long and short fragments
Three subfamilies:-
Alphaherpesviruses - HSV-1, HSV-2, VZV
Betaherpesviruses - CMV, HHV-6, HHV-7
Gammaherpesviruses - EBV, HHV-8
Set up latent or persistent infection following primary
infection
Reactivation - periods of immunosuppression
Both primary infection and reactivation - more serious in
immunocompromised patients.
6. HSV is highly ubiquitous
Leading cause of unilateral corneal blindness in the
developing world.
80%-90% of adults have been infected
25% have ocular manifestation of disease
95% of clinical disease is seen as a reoccurrence
Reoccurrence of can be triggered by variety of sources
Ocular HSV tends to be a unilateral disease with
only one eye affected by primary disease in
approximately 80-90% of cases
7. Modes of infection
HSV - commonly acquired in adolescence than in
childhood
IP = 3-9 days
Humans are natural reservoir of HSV
Children with primary disease
Adults with recurrent disease
Healthy asymptomatic carrier
9. Pathophysiology
Enters a peripheral
nerve
Travels by axonal
transport to neuronal
cell bodies
Into the nucleus of
the neuron on the
superior cervical
ganglia and the
trigeminal ganglia.
10.
11. HSV cycle –
• HSV is epitheliotrophic
• Affects ectodermic tissue
Attach to sp receptor on human cells‣‣ enter cells by
pinocytosis‣‣ viral DNA released into cells ‣‣ In the nucleus
thymidine kinase and DNA polymerase are formed‣‣ Viral
proteins are synthesized in cytoplasm‣‣ transferred to
nucleus‣‣ nuclear caspid is assembled‣‣ it gains envelope
breaking through nuclear membrane
12.
13. Latency
Ganglia in a latent
state.
Reactivated, it travels
via the axons to the
cornea
Shed and produce
recurrent disease in
cornea
14. Primary infection
Occurs by direct inoculation
Newborns protected by anti-herpetic antibodies
Most cases subclinical
Primary HSV-1 infection -commonly on skin and mucosal
surfaces innervated by CN V.
HSV manifests by ---
Cutaneous involvement
Vesicular periocular skin eruptions, vesicular ulcerative
blepharitis
Acute follicular conjunctivitis.
22. HSV ocular infection different from that associated with
Adenovirus include-
Cutaneous or eyelid margin vesicles, or ulcers on the
bulbar conjunctiva (HSV)
Dendritic epithelial keratitis (HSV)
Conjunctival membranes or pseudo-membrane
(adenovirus)
23. Wellard and schwartz classification
(1) Infectious epithelial keratitis,= Cornea vesicles,
dendritic ulcer, geographic ulcer, and marginal ulcer.
(2) Neurotrophic keratopathy= Punctate epithelial
erosions and neurotrophic ulcer.
(3) Stromal keratitis=Necrotizing stromal keratitis
and immune stromal keratitis.
(4) Endothelitis, =Disciform, diffuse, and linear.
Wellard , schwartz Department of Ophthalmology, University of Minnesota, Minneapolis 55455-0501,
Cornea 1999 Mar;18(2):144-54
24. Laboratory evaluation
Serologic tests for neutralizing or complement-fixing
immunoglobulins may show a rising antibody titer during
primary infection
No diagnostic assistance during recurrent episodes
Indicated in complicated cases when the clinical diagnosis
is uncertain and in all cases of suspected neonatal herpes
infection
25. Vesicular fluid can be cultured
Scrapings from the vesicle base
Conjunctival scrapings or impression cytology specimens
can be similarly analyzed by culture, antigen detection, or
PCR.
26. MANAGEMENT
Primary ocular
HSV infection is
a self-limited
condition.
Oral antiviral
therapy speeds
resolution of
signs and
symptoms
27.
28. Recurrent ocular infection
Pathogenesis -
Recurrent HSV infection - by reactivation of the virus
in a latently infected sensory ganglion,
Transport of the virus down the nerve axon to sensory
nerve endings, and subsequent infection of ocular
surface epithelia
29. Corneal Signs-
Patients with primary ocular HSV infection can develop epithelial
keratitis.
There are many presentations dependent of the strain of the virus.
We can have punctate keratitis, or dendritic lesions.
31. Lesions:-
Dendritic ulcer-
Most characteristic lesion,
occurs in corneal epithel.
Typical branching, linear
pattern with feathery edges
and terminal bulbs at ends.
Visualized by fluorescein
staining Usually multiple
and small dendrites with
“terminal bulbs” in
primary infection
32. Dendritic keratitis -
Debridement can be curative
Live virus
Risk of recurrence is 30% within 2 years
This patient suffers from herpetic keratitis.
Fluorescein staining reveals dendritic ulcer typical of herpes
keratitis.
36. Epithelial Keratitis
Usually single “beefier”
dendrites
Live virus
Assoc. with decrease
corneal sensation and
patchy iris atrophy
Can leave “ghost
dendritic” scar when
healed (as in primary
infection)
37. Dendritic epithelial lesions include-
VZV (see the discussion later in the chapter)
Adenovirus (uncommon)
EBV (rare)
Epithelial regeneration line
Neurotrophic keratopathy (postherpetic, diabetes)
Soft contact lens wear (thimerosal)
Topical medications (antivirals, β-blockers)
Acanthamoeba epithelial keratitis
Epithelial deposits (iron lines, Fabry disease,
tyrosinemia type II, systemic drugs)
38. Geographic ulceration
Form of chronic dendritic
disease.
Particularly with use of
topical corticosteroids
Delicate dendritic lesions
take a broader form.
Corneal sensation is
diminished
39. Stromal Keratitis-
Herpetic stromal keratitis
can be non-necrotizing
(interstitial or disciform)
or
Necrotizing, and different
forms may present
simultaneously
40. Direct viral invasion of the stroma
An immune process
White
Heavily Infiltrated
Necrotic
Thinning
Near Perforation
42. Disciform keratitis-
Most common form of stromal
disease in HSV infection.
Edematous stroma without
significant infiltration and
without vascularization.
Edema is most prominent
sign.
Keratic precipitates may lie
directly under disciform lesion
but may also involve the
endothelial lesion.
Vaughan & Asbury’s General
Ophthalmology 16th Edition, 136
43. Herpetic disciform
keratitis is a Primary
Endothelitis
Presents as corneal
stromal and epithelial
edema in a round or oval
pattern
In Disciform keratitis,
disc-shaped stromal
edema and kps appear
out of proportion to the
degree of ant chamber
reaction
45. Necrotizing herpetic keratitis
appears as suppurative corneal
inflammation
It may be severe, progress
rapidly, and appear clinically
indistinguishable from
fulminant bacterial or fungal
keratitis
Corneal stromal vascularization
is common
50. Management
Many past controversies regarding the optimal
management of HSV stromal keratitis have been
resolved by the HEDS trial
HEDS findings showed that topical corticosteroids
given together with a prophylactic antiviral reduce
persistence or progression of stromal inflammation
and shorten the duration of HSV stromal keratitis
Long-term suppressive oral acyclovir therapy reduces
the rate of recurrent HSV keratitis and helps preserve
vision.
53. Iridocyclitis-
Granulomatous or non
granulomatous iridocyclitis may
accompany necrotizing stromal
keratitis or occur independently of
corneal disease.
Main feature= Elevated intraocular
pressure (IOP) caused by
trabeculitis and/ may be found in
patients with HSV iridocyclitis.
Diagnosis - by a unilateral
presentation associated with an
elevated IOP with or without focal
iris transillumination defects.
54. Complications of infectious epithelial
keratitis
Complications of herpetic eye disease affect all layers of
the cornea
Resolve without corneal scar formation
Subepithelial scarring
Dense stromal scarring
Corneal thinning
Dendritic epitheliopathy
Neurotrophic keratopathy
Stromal keratitis
55. Metaherpetic Ulcer
Chronic sterile macro-
ulceration
No stromal infiltration
Epithelium unable to
heal
May be Associated with
toxicity of Antiviral
drops
TX: Stop or taper off
antiviral drugs
Lubrication
61. Cidofovir 0.2% and 1% (Vistide), qid
FDA approved for CMV (1996), I.V.
Interferes with DNA polymerase
Local toxicity
Antiviral resistance
63. HEDS study One:
Oral acyclovir for herpes simplex for STROMAL
keratitis (n = 104)
PO acyclovir (n=51) vs. topical steroids and trifluridine
(n=53)
Included both necrotizing and non-necrotizing stromal
keratitis
No clinically significant beneficial effect of oral
acyclovir in treating HSV stromal keratitis
receiving concomitant steroid and trifluridine gtts.
Barron BA, Gee L, Haouck WW, et al. Herpetic Eye Disease study. A controlled trial of oral acyclovir for herpes simplex
stromal keratitis. Ophthalmol 1994, 101:1883-1896.
64. HEDS: Study Two
Topical corticosteroids for herpes simplex
STROMAL keratitis (n=106)
Placebo (n=49) vs. steroid group (n=57) tapered over 10
weeks. Both groups received topical trifluridine.
Corticosteroid tx reduced the risk of persistent or
progressive stromal keratouveitis by 68%
Topical Steroid treatment was significantly
better than placebo in reducing persistence or
progression of stromal inflammation and in
shortening the duration.
Wilhelmus KR, Gee L, Hauck WW et al. Herpetic Eye Disease Study Group. A controlled trial of topical corticosteroids
for herpes simples stromal keratitis. Ophthalmol 1994, 101:1883-1896.
65. HEDS: Study Three
Evaluate adding oral acyclovir to a regimen of
topical prednisolone phosphate and trifluridine
for HSV iridocyclitis. (n=50)
10-week course of acyclovir 400 mg 5x/day
Treatment failure in 50% of the acyclovir treated group
(n=22) vs. 68% in placebo (n=28)
Possible benefit of PO acyclovir for HSV
iridocyclitis. # pts too small for statistically
significant result.
Herpetic Eye Disease Study Group. A controlled trial of oral acyclovir for iridocyclitis caused by herpes simplex virus.
Arch Ophthalmol 1996, 114:1065-1072.
66. HEDS: Study Four
Oral acyclovir for the PREVENTION of stromal
keratitis or HSV iritis in patients with EPITHELIAL
keratitis. (n=287)
3 week course of PO acyclovir 400 mg 5x/day (n=153) vs.
placebo (n=134) in addition to trifluridine for their
epithelial disease.
Stromal keratitis or iritis developed in 11% of the
acyclovir group and in 10% of the placebo
No benefit of 3-week course of PO acyclovir for
pts with epithelial disease in preventing HSV
stromal keratitis or iritis.
The Herpetic Eye Disease Study Group: the epithelial keratitis trial. A controlled trial of oral acyclovir for the prevention of
stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis. Arch Ophthalmol 1997, 115:703-712.
67. HEDS: Study Five
Oral acyclovir as prophylaxis for the prevention of
recurrent ocular HSV disease. (n=346)
12 month treatment period at 400 mg BID (n=357) vs.
placebo (n=346)
Recurrence of any type of ocular HSV was 19% in
acyclovir group and 32% in the placebo group.
The Herpetic Eye Disease Study Group: acyclovir for the prevention of recurrent herpes simplex virus eye disease. N
Engl J Med 1998, 339:300-306.
68. HEDS: Trial Five
In a subset of patients with a history of stromal
keratitis, the probability of recurrent stromal
keratitis was 14% in the acyclovir group and 28% in
placebo group.
The probability of a recurrence of non-ocular
(orofacial) HSV disease was also lower in the
acyclovir group (19% vs 36%)
Oral acyclovir prophylaxis for one year
significantly reduces the risk of recurrent
ocular and orofacial HSV, especially in pts with
previous stromal keratitis.
The Herpetic Eye Disease Study Group: acyclovir for the prevention of recurrent herpes simplex virus eye disease. N
Engl J Med 1998, 339:300-306.
69. Prophylactic oral
acyclovir use after PK
for HSV keratitis is
associated with
decreased episodes
of rejection and
improved graft
survival
Garcia DD, Farjo Q, Musch DC, et al. Effect of prophylactic oral acyclovir after penetrating keratoplasty for herpes
simplex keratitis. 2007, 26:930-934.
70. Recent review (2007) on tx of HSV epithelial
keratitis support the use of topical trifluridine and
topical or oral acyclovir, and suggest a possible
additional benefit for topical interferon.
Wilhelmus KR. Therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Syst. Rev
2007, 1:CD002898
71. One year suppression therapy with PO
valacyclovir (500 mg QDay) was shown to be as
effective and as well tolerated as acyclovir (400 mg
BID) in reducing the rate of recurrent ocular HSV
disease
Miserocchi E, Modorati G, Galli L, et al. Efficacy of valacyclovir vs. acyclovir for the prevention of recurrent herpes simplex
eye disease. A pilot study. 2007, 144:547-551.
72. Herpes Zoster Virus
Varicella-Zoster
Long History
VZV causes a primary infection (varicella, or
chickenpox)
Subsequent latency, occasionally followed later by
recurrent disease (zoster, or shingles)
Primary VZV infection = direct contact with VZV skin
lesions or respiratory secretions via airborne droplets.
73. Highly contagious for naive individuals
VZV infection = Self limited infection of childhood
rarely associated with long-term sequelae
Infection of adults or immunosuppressed can be fatal
74. HZV Risk Factors -
Age-
Immunodeficient conditions:-
AIDS
SLE
Radiation Therapy
Immuno-suppresion from medical therapies
Systemic malignancy
Radiation injury
75. HZV Infection
Primary infection-from a contagious individual
Initially infects the upper respiratory mucosa or
conjunctiva.
Infects the capillary endothelium
spreads locally to the epidermis
As with HSV, VZV latency occurs in neural ganglia and, in
approximately 20% of infected individuals, reactivates
later.
Of all cases with zoster, 15% involve the ophthalmic
division of CN V (trigeminal)
76. Pathology-
Trigeminal nerve
Infiltrated with lymphocyte
Infiltration of the Long Post Ciliary Nerve
Causes demyelination
Sensory cells
Sensory nucleus in the brainstem
77.
78. Herpes Zoster Signs and Symptoms
Ophthalmic Signs-
Mucopurulent discharge
Fine punctate epithelial
keratitis
Dendritic keratitis
Non-Eye Signs/Sx-
Redness & warmth
Dermatological pain
Tic Douloureux
Vesicular skin lesions
Fever
Malaise
Depression.
Most common
dermatome=T3 to L3 &
supplied by CN 5
79. Skin Lesions
60% experience dermatomal pain
before skin lesions
Macule-Papules –vesicle-pustule
Vesicles - Serous fluid
Pustule- pus filled- ruptured
become covered with crusts
Lesions do not cross the midline
of the face
80. Hutchinson sign-
Vesicles on the tip of the nose,
or vesicles on the side of the
nose, precedes the
development of
ophthalmic herpes zoster
This occurs because
the nasociliary branch of
the trigeminal
nerve innervates both
the cornea and the lateral
dorsum of the nose as well as
the tip of the nose.
82. Ocular Findings
Punctate epithelial
keratitis (PEK)
As early as one or two days
after the initial skin rash.
Follicular conjunctivitis
Pseudo-dendritic keratitis
w/o terminal bulbi
Stromal inflammation
Neurotrophic keratitis
Rare Findings-
Disciform keratitis Uveitis,
retinitis.
83. Nummular corneal
infiltrates = characteristic
of zoster stromal keratitis
Chronic corneal stromal
inflammation can lead to
corneal vascularization &
lipid keratopathy
84. Diagnosis-
Clinical Presentations (mainly)
Scraping from ulcer base, conjunctival Scrapings
or corneal impression cytology
Immunological Reaction
FAMA
Fluorescent antibody to viral membrane antigen
ELISA
PCR
Cytology
85. Prevention-
A varicella-zoster vaccine was approved by the US
Food and Drug Administration (FDA) showed-
a 50% reduction in incidence of zoster and
a 66% reduction in postherpetic neuralgia
88. The current recommendation for HZO is-
Oral famciclovir 500 mg 3 times per day,
valacyclovir 1 g 3 times per day,
Acyclovir 800 mg 5 times per day for 7–10 days,
Best if started within 72 hours of the onset of skin lesions
Intravenous Acyclovir therapy (10 mg/kg every 8 hours)
is indicated in patients at risk for disseminated zoster
due to immunosuppression.
90. Ocular Disease
Must rule out H. simplex
Topical corticosteroids
Oral acyclovir
Artificial Tears
91. Adenoviral Infections
Adeno- (Greek): meaning of a gland or glands.
Forty-nine serotypes subdivide into 6 distinct
subgroups (A–F) on the basis of genetic sequencing.
D adenoviruses are strongly associated with epidemic
keratoconjunctivitis
Gland: A specialized group of cells or organ that
separates certain elements from the blood and
secretes them.
92. Adenoviral Infections -
• Adenovirus- small, non-enveloped, DS-DNA
• Resistant to lipid solvents
• At least 49 identified Serotypes
Most adenoviral eye disease presents clinically as 1 of 3 classic
syndromes:
Simple follicular conjunctivitis (multiple serotypes)
Pharyngoconjunctival fever (most commonly serotype 3 or 7)
Epidemic keratoconjunctivitis (EKC; usually serotype 8, 19, or
37, subgroup D)
93. EKC
Usually transferred by hands, instruments, and
solutions.
Epidemics usually arise from optometrists and
ophthalmologists offices.
Adenovirus can survive 35 days on a variety of surfaces
Patients remain infectious for 14 days after onset of
symptoms
96. 21 day course
Initial 7 days: exposure to onset of symptoms
Days 7 & 8: conjunctival changes
Days 9 & 10: appearance of Punctate Epithelial Keratitis
Days 11 & 12: appearance of Sub Epi Infiltrate