Download - Herpes Zoster Ophtalmicus
REFERAT Komplikasi Herpes Zoster Oftalmikus pada
kornea, gejala, dan penanganannya
Oleh : Vicky Lumalessil (406151039)
Pembimbing :
Dr. Saptoyo A. M, SpM
Herpes Zoster Ophtalmicus
Reaktifasi varisela zoster virus (VZV) pada bagian oftalmikus yaitu nervus trigeminal (N V1), yang didahului oleh infeksi primer varicela sebelumnya chicken pox.
Pathophysiology Following Primary infection of VZV
Dorsal Root of Sensory neural Ganglion
Dormant
Activated VZV
VZV specific cell mediated immunity faded
Central Nervous System
Dermatologic involvement
Optical system Auditory System
Trigeminal Nerve Anatomy
Clinical Manifestation
A. Vesicles B. Confluent crusting
C. Haemorrhagic rash with involvement of both the ophthalmic and maxillary nerve
D. Residual Scarring
Clinical Manifestation
Acute Eye Diseases
• Conjunctivitis (follicular and/or papillary)
• Episcleritis, Scleritis
• Keratitis (Acute Epithelial, Nummular, Stromal, Disciform)
• Anterior Uveitis with Sectoral iris ischeamia and atrophy
• IOP elevated
• Retinitis, choroiditis
• Neurological Complication
Clinical Manifestation
A. Dendritic epithelial lesions with tapered ends B. Nummular keratitis
C. Stromal Keratitis
Clinical Manifestation
Chronic Eye Diseases
• Neurotrophic keratitis 50% cases
• Scleritis patchy slceral atrophy
• Mucous plaque keratitis 5%, between 3rd and 6th month
• Lipid degeneration in eye with persistent severe nummular or disci form keratitis
• Lipid-filled granulomata under tarsal conjunctiva together with subconjunctival
scarring
• Eyelid scarring result in ptosis, cicatrices entropion and occasionally ectropion
Clinical Manifestation
A. Scleral atrophy B. Mucous Plaque Keratitis C. Lipid filled granuloma
Cicatricial entropion Cicatricial ectropion
Clinical Manifestation
Postherpetic Neuralgia
• Pain persist > 1 month after rash healed
• 75% of patient over 70 Yrs
• Pain (Constant or intermittent), worse at night and aggravated by minor stimuli, touch and heat.
Diagnosis
• The diagnosis of herpes zoster disease is based on clinical findings
• Direct detection of the virus and indirect serological detection of specific antibodies
• Cytologic examination of cutaneous vesicular scrapings reveals multiple eosinophilic intranuclear inclusions (Lipschutz bodies) and multinucleated giant cells (Tzanck preparation)
• Electron microscopy
• VZV-DNA can also be directly detected in clinical specimens using real-time PCR
Management • Systemic medication-
– Oral acyclovir (800 mg, five times daily) for 7–10 days
– Famciclovir (500 mg three times daily for 7 days)
– Valacyclovir (1000 mg three times daily)
• Epithelial disease- Acyclovir ointment 5 times a day for 3 weeks
• Stromal disease- Acyclovir ointment 5 times a day with 1% prednisolone acetate in tapering doses
• Endothelitis- Intensive prednisolone acetate 1% with systemic Acyclovir 400 mg 5 times a day