The Painful Eye: External and Anterior Segment Causes

Herpes Zoster Ophthalmicus: How Is It Identified and Treated?

“…Annually there are approximately 3 million cases of chickenpox and about 300,000 cases of HZ reported each year in the United States. Of these cases, 10%-20% are classified as HZO, and are equally distributed between men and women (Brownstein, 2000;Cutarelli, & Aronsky, 1999;Liesegang, 1991).…”

“…These symptoms mimic life-threatening neurological, and/or vision threatening disorders; hence necessitating a meticulous history from the patient. (Berger, 1999;Brownstein, 2000;Coombs, & Gnann, 1994;Cutarelli, & Aronsky, 1999;Moore, & Dalley, 1999).…”

“…An erythematous presentation on the tip of the nose (Hutchinson sign) may be the first observable feature following the onset of pain. A Hutchinson sign becomes evident because of viral involvement affecting the nasocilliary branch of the ophthalmic division of the trigeminal nerve (Brownstein, 2000;Coombs, & Gnann, 1994;Cutarelli, & Aronsky, 1999;Verghese, Kachroo, & Sparr, 1997).…”

“…Overall, it is estimated that 66% of individuals affected by HZO have corneal involvement (keratitis), and 40% have inflammation of the anterior uveal tract as the second most common (40%) structure affected. Early identification and initiation of treatment within 48 hours is essential to prevent ocular complications (Coombs, & Gnann, 1994;Cutarelli, & Aronsky, 1999;Krimmer, 1994;Liesegang, 1991).…”

“…During the prodromal phase, the use of acyclovir has been proven effective in shortening the disease process and decreasing the potential for developing PHN. Acyclovir reduces viral replication, accelerating the healing of skin lesions and shortening the period of acute pain (Berger, 1999;Brownstein, 2000;Chandrasekar, 1999;Cutarelli & Aronsky, 1999;Fitzpatrick et al, 1997;Huff et al, 1988;Krimmer, 1994;Liesegang, 1991;Verghese et al, 1997). A dosage of 800 mg, five times daily for five days by mouth, plus oral prednisone has been demonstrated as the most effective Berger, 1999;Coombs & Gnann, 1984;Dolin et al, 1978;Fitzpatrick et al, 1997. Berger, 1999;Fitzpatrick et al, 1997;Kirkiakopoulos, Gorn, & Barton, 1998;Mackenzie, Ryan, Karnes, & Okazaki, 1987;Levine, 1996;Uphold, & Graham, 1999;Whallett, & Pahor, 1999;Verghese et al, 1997. treatment regimen against a HZ infection (Huff et al, 1988).…”