Dendritic Lesions in Herpes Zoster Ophthalmicus

Chronic Varicella-zoster Virus Epithelial Keratitis in Patients With Acquired Immunodeficiency Syndrome

“…Mucolytics had no discernible effect on the epithelial lesions in our patients. The dendriform lesions described herein may therefore more closely resemble those described by Piebenga and Laibson 7 and more recently by Pavan-Langston et al 8 In that study, 8 these lesions had a positive result for VZV DNA by polymerase chain reaction testing and responded variably to topical antiviral medications. To date, however, in patients without AIDS, we have been unable to amplify by polymerase chain reaction techniques VZV DNA from chronic mucus plaques that resemble lesions described by Marsh and Cooper.…”

“…These le-sions tend not to respond to antiviral medications. The clinical appearance of the dendriform lesions in our patients resembled in some ways that of mucus plaques; however, in contrast to the late lesions described by Marsh and Cooper 6 and others, 5,7 the epithelial lesions in our patients crossed the limbus, were associated with pain, and, in many cases, had either recoverable virus or VZV antigen. In addition, the epithelial lesions in many of our patients responded to antiviral medications, then worsened or recurred when the antiviral medications were discontinued.…”

“…Third, the lesions in our patients were chronic, persisting for weeks to months, and, in many cases, first appeared months after a zosteriform rash. Chronic epithelial pseudodendrites, or mucus plaques, as described by Marsh and Cooper 6 and others 5,7 can occur from 7 days to 2 years following herpes zoster ophthalmicus. These transitory plaques are gray, elevated, linear or branching, and stain well with rose bengal and poorly with fluorescein.…”

Chronic Varicella-zoster Virus Epithelial Keratitis in Patients With Acquired Immunodeficiency Syndrome

“…Mucolytics had no discernible effect on the epithelial lesions in our patients. The dendriform lesions described herein may therefore more closely resemble those described by Piebenga and Laibson 7 and more recently by Pavan-Langston et al 8 In that study, 8 these lesions had a positive result for VZV DNA by polymerase chain reaction testing and responded variably to topical antiviral medications. To date, however, in patients without AIDS, we have been unable to amplify by polymerase chain reaction techniques VZV DNA from chronic mucus plaques that resemble lesions described by Marsh and Cooper.…”

“…These le-sions tend not to respond to antiviral medications. The clinical appearance of the dendriform lesions in our patients resembled in some ways that of mucus plaques; however, in contrast to the late lesions described by Marsh and Cooper 6 and others, 5,7 the epithelial lesions in our patients crossed the limbus, were associated with pain, and, in many cases, had either recoverable virus or VZV antigen. In addition, the epithelial lesions in many of our patients responded to antiviral medications, then worsened or recurred when the antiviral medications were discontinued.…”

“…Third, the lesions in our patients were chronic, persisting for weeks to months, and, in many cases, first appeared months after a zosteriform rash. Chronic epithelial pseudodendrites, or mucus plaques, as described by Marsh and Cooper 6 and others 5,7 can occur from 7 days to 2 years following herpes zoster ophthalmicus. These transitory plaques are gray, elevated, linear or branching, and stain well with rose bengal and poorly with fluorescein.…”

Corneal Epithelial Keratitis in Herpes Zoster Ophthalmicus: “Delayed” and “Sine Herpete”. a Non-contact Photomicrographic in Vivo Study in the Human Cornea

“…Some patients were treated with topical acyclovir but, since the resolution occurred during a period compatible with spontaneous healing, the effect of the drug -if any -could not be decided; the effect of topical antivirals on classical acute HZO seems to be unsettled (reviewed by Liesegang,1). The second drug, topical cortisone, used to treat anterior segment disease before and during the epithelial keratitis, did not have any discernible effect of the epithelial changes; nor does the literature indicate any effect of topical cortisone on classical acute HZO lesions (23).…”

Ocular effects caused by viral infections and corresponding vaccines: An overview of varicella zoster virus, measles virus, influenza viruses, hepatitis B virus, and SARS-CoV-2

“…The cornea is the ocular structure more frequently involved (about 65% of cases) (12,(15)(16)(17): HZO can produce corneal surface epithelial keratitis (12)(13)(14), pseudodendrites (10,13,14), anterior stromal infiltrates (12,14), late corneal mucous plaques keratitis (MPK) (18,19), disciform keratitis (12,14), endothelitis with potential subsequent loss of endothelial cells (20), neurotrophic keratitis due to involvement of the sensory nerve with corneal hypoesthesia or anesthesia (10,16,21), or exposure keratitis, if associated with an eyelid defect (12). In the most severe forms, corneal ulceration and even perforation could appear, generally at perilimbar level (12,15,22).…”

Chronic Varicella-zoster Virus Epithelial Keratitis in Patients With Acquired Immunodeficiency Syndrome

“…Mucolytics had no discernible effect on the epithelial lesions in our patients. The dendriform lesions described herein may therefore more closely resemble those described by Piebenga and Laibson 7 and more recently by Pavan-Langston et al 8 In that study, 8 these lesions had a positive result for VZV DNA by polymerase chain reaction testing and responded variably to topical antiviral medications. To date, however, in patients without AIDS, we have been unable to amplify by polymerase chain reaction techniques VZV DNA from chronic mucus plaques that resemble lesions described by Marsh and Cooper.…”

“…These le-sions tend not to respond to antiviral medications. The clinical appearance of the dendriform lesions in our patients resembled in some ways that of mucus plaques; however, in contrast to the late lesions described by Marsh and Cooper 6 and others, 5,7 the epithelial lesions in our patients crossed the limbus, were associated with pain, and, in many cases, had either recoverable virus or VZV antigen. In addition, the epithelial lesions in many of our patients responded to antiviral medications, then worsened or recurred when the antiviral medications were discontinued.…”

“…Third, the lesions in our patients were chronic, persisting for weeks to months, and, in many cases, first appeared months after a zosteriform rash. Chronic epithelial pseudodendrites, or mucus plaques, as described by Marsh and Cooper 6 and others 5,7 can occur from 7 days to 2 years following herpes zoster ophthalmicus. These transitory plaques are gray, elevated, linear or branching, and stain well with rose bengal and poorly with fluorescein.…”

Corneal Epithelial Keratitis in Herpes Zoster Ophthalmicus: “Delayed” and “Sine Herpete”. a Non-contact Photomicrographic in Vivo Study in the Human Cornea

“…Some patients were treated with topical acyclovir but, since the resolution occurred during a period compatible with spontaneous healing, the effect of the drug -if any -could not be decided; the effect of topical antivirals on classical acute HZO seems to be unsettled (reviewed by Liesegang,1). The second drug, topical cortisone, used to treat anterior segment disease before and during the epithelial keratitis, did not have any discernible effect of the epithelial changes; nor does the literature indicate any effect of topical cortisone on classical acute HZO lesions (23).…”

Ocular effects caused by viral infections and corresponding vaccines: An overview of varicella zoster virus, measles virus, influenza viruses, hepatitis B virus, and SARS-CoV-2

“…The cornea is the ocular structure more frequently involved (about 65% of cases) (12,(15)(16)(17): HZO can produce corneal surface epithelial keratitis (12)(13)(14), pseudodendrites (10,13,14), anterior stromal infiltrates (12,14), late corneal mucous plaques keratitis (MPK) (18,19), disciform keratitis (12,14), endothelitis with potential subsequent loss of endothelial cells (20), neurotrophic keratitis due to involvement of the sensory nerve with corneal hypoesthesia or anesthesia (10,16,21), or exposure keratitis, if associated with an eyelid defect (12). In the most severe forms, corneal ulceration and even perforation could appear, generally at perilimbar level (12,15,22).…”

Chronic Varicella-zoster Virus Epithelial Keratitis in Patients With Acquired Immunodeficiency Syndrome

“…Mucolytics had no discernible effect on the epithelial lesions in our patients. The dendriform lesions described herein may therefore more closely resemble those described by Piebenga and Laibson 7 and more recently by Pavan-Langston et al 8 In that study, 8 these lesions had a positive result for VZV DNA by polymerase chain reaction testing and responded variably to topical antiviral medications. To date, however, in patients without AIDS, we have been unable to amplify by polymerase chain reaction techniques VZV DNA from chronic mucus plaques that resemble lesions described by Marsh and Cooper.…”

“…These le-sions tend not to respond to antiviral medications. The clinical appearance of the dendriform lesions in our patients resembled in some ways that of mucus plaques; however, in contrast to the late lesions described by Marsh and Cooper 6 and others, 5,7 the epithelial lesions in our patients crossed the limbus, were associated with pain, and, in many cases, had either recoverable virus or VZV antigen. In addition, the epithelial lesions in many of our patients responded to antiviral medications, then worsened or recurred when the antiviral medications were discontinued.…”

“…Third, the lesions in our patients were chronic, persisting for weeks to months, and, in many cases, first appeared months after a zosteriform rash. Chronic epithelial pseudodendrites, or mucus plaques, as described by Marsh and Cooper 6 and others 5,7 can occur from 7 days to 2 years following herpes zoster ophthalmicus. These transitory plaques are gray, elevated, linear or branching, and stain well with rose bengal and poorly with fluorescein.…”

Corneal Epithelial Keratitis in Herpes Zoster Ophthalmicus: “Delayed” and “Sine Herpete”. a Non-contact Photomicrographic in Vivo Study in the Human Cornea

“…Some patients were treated with topical acyclovir but, since the resolution occurred during a period compatible with spontaneous healing, the effect of the drug -if any -could not be decided; the effect of topical antivirals on classical acute HZO seems to be unsettled (reviewed by Liesegang,1). The second drug, topical cortisone, used to treat anterior segment disease before and during the epithelial keratitis, did not have any discernible effect of the epithelial changes; nor does the literature indicate any effect of topical cortisone on classical acute HZO lesions (23).…”

Ocular effects caused by viral infections and corresponding vaccines: An overview of varicella zoster virus, measles virus, influenza viruses, hepatitis B virus, and SARS-CoV-2

“…The cornea is the ocular structure more frequently involved (about 65% of cases) (12,(15)(16)(17): HZO can produce corneal surface epithelial keratitis (12)(13)(14), pseudodendrites (10,13,14), anterior stromal infiltrates (12,14), late corneal mucous plaques keratitis (MPK) (18,19), disciform keratitis (12,14), endothelitis with potential subsequent loss of endothelial cells (20), neurotrophic keratitis due to involvement of the sensory nerve with corneal hypoesthesia or anesthesia (10,16,21), or exposure keratitis, if associated with an eyelid defect (12). In the most severe forms, corneal ulceration and even perforation could appear, generally at perilimbar level (12,15,22).…”