DEPARTMENT OF OPHTHALMOLOGY

SINDH GOVT. QATAR HOSPITAL

DR MARIAM KASHIF
POST GRADUATE STUDENT(MCPS)

DR JAMEEL AHMED BURNEY

SUPERVISOR/HEAD OF DEPARTMENT
 Case
A 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
 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.
 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.
 Family and Social History

 Unmarried, lives with parents and two

siblings; all healthy.
 No addictions.
 Works in garment factory.
 Belongs to middle class family.
 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.
 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. (Hutchinson's Sign)
 Bilateral Ocular Motility normal
 Pupillary reactions normal
 Slit Lamp Examination
RIGHT EYE LEFT EYE
Conjunctiva Normal Hyperemia
Cornea Clear Ulcer (Dendritic in
Sensation pattern
normal Fluorescine +ve)
Sensation reduced
Anterior Normal Normal
chamber
Lens Clear Clear
Fundus Normal Normal
 Differential Diagnosis

OCULAR SKIN
Herpes simplex keratitis Drug allergy
Herpes zoster ophthalmicus Contact dermatitis
Insect bite
 Diagnosis

HERPES ZOSTER OPHTHALMICUS

 History
 Vesicles (Hutchinson’s Sign)
 Dendritic ulcer
 Varicella zoster virus
 Double stranded DNA virus
 Alphaherpesvirinae
 Overview
VARICELLA ZOSTER VIRUS
Chicken pox dorsal root ganglia reactivation shingles
single dermatome
 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
 Watering/Discharge
 Photophobia
 Decreased vision
 Signs (Ex.Ocular)
 Hutchinson’s Sign

( vesicles on forehead, upper eyelid, side &

tip of nose)
Hutchinson's 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
 Keratic precipetates (KPs)

Posterior Synachiae
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 (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
 Ocular complications

 Eyelid scarring
 Raised IOP (steroid induced)
 Neurotrophic keratitis
 Chronic scleritis
 Lipid degeneration (cornea)
 Treatment
Systemic :
Within 72hrs

Acyclovir 800mg 5 times daily

Famciclovir 500mg TID

 Treatment
Local:
 Acyclovir skin ointment (rash)
 Topical Acyclovir
 Topical antibiotics (Chloramphenicol)
 Topical steroids (uveitis)
 Treatment of Complications
Post herpetic neuralgia
 Cold compress
 Local CAPSAICIN oint (QID) /
LIDOCAINE oint
 Pain killers
 Oral Tricyclic antidepressants

No Post herpetic neuralgia

 Message

 A common and treatable viral infection.

 Patient education/Counseling.
 Post herpetic neuralgia is extremely
painful condition.
 Can transmit chicken pox.