Optic neuritis complicating herpes zoster ophthalmicus in an immunocompetent patient

Abstract

The authors declare no conflicts of interestRecebido para publicação em 3/7/2014 -Aceito para publicação em 11/7/2014 ABSTRACTA 58-year-old woman presented with rash over the left side of the face and intense acute uveitis. Following careful review of the symptoms and dilated fundus examination unilateral optic neuritis was discovered. The rash was typical of varicella zoster dermatitis. Patients presenting with herpes zoster ophthalmicus should always undergo dilated fundus examination, as there is a potential risk of unexpected posterior segment inflammation. Early diagnosis and prompt treatment can avoid visual sequelae.Keywords

Complete Recovery of Vision in Herpes Zoster Optic Neuropathy with Intravenous Acyclovir

“…7,8 However, our review of literature demonstrated that no HZON case was treated with a dose as high as oral valacyclovir 2 g QID, with the highest dose being 1 g TID in five cases. 2 The higher dose equivalent achieved with intravenous acyclovir may have been important in our patient's recovery. Some have advocated for oral valacyclovir over intravenous acyclovir because of a better safety profile due to lower peak concentration and good central nervous system penetration.…”

“…1 In our review of literature, we retrieved 32 cases of HZON with a final visual outcome of 20/20 reported in 3 cases. [2][3][4] The presenting visual acuity was 20/200 in two cases and 20/120 in one case. [2][3][4] Since our patient started with CF vision, he represents the largest recovery to normal vision reported in literature.…”

“…[2][3][4] The presenting visual acuity was 20/200 in two cases and 20/120 in one case. [2][3][4] Since our patient started with CF vision, he represents the largest recovery to normal vision reported in literature. In the three cases that returned to 20/20, treatment included oral or intravenous corticosteroids in all cases.…”

“…In the three cases that returned to 20/20, treatment included oral or intravenous corticosteroids in all cases. [2][3][4] However, the use of corticosteroids in the treatment of HZON remains controversial as there are no randomized controlled trials or prospective studies to support its use. Opponents of corticosteroid use in HZON argue that there is a risk of VZV retinitis with evidence stemming from case reports of patients with optic neuropathies who were treated with corticosteroids when the diagnosis of herpetic disease was not yet established.…”