herpes zoster ophtalmicus
DESCRIPTION
Presentasi CaseTRANSCRIPT
![Page 1: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/1.jpg)
REFERAT Komplikasi Herpes Zoster Oftalmikus pada
kornea, gejala, dan penanganannya
Oleh : Vicky Lumalessil (406151039)
Pembimbing :
Dr. Saptoyo A. M, SpM
![Page 2: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/2.jpg)
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.
![Page 3: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/3.jpg)
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
![Page 4: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/4.jpg)
Trigeminal Nerve Anatomy
![Page 5: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/5.jpg)
Clinical Manifestation
A. Vesicles B. Confluent crusting
C. Haemorrhagic rash with involvement of both the ophthalmic and maxillary nerve
D. Residual Scarring
![Page 6: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/6.jpg)
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
![Page 7: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/7.jpg)
Clinical Manifestation
A. Dendritic epithelial lesions with tapered ends B. Nummular keratitis
C. Stromal Keratitis
![Page 8: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/8.jpg)
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
![Page 9: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/9.jpg)
Clinical Manifestation
A. Scleral atrophy B. Mucous Plaque Keratitis C. Lipid filled granuloma
Cicatricial entropion Cicatricial ectropion
![Page 10: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/10.jpg)
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.
![Page 11: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/11.jpg)
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
![Page 12: Herpes Zoster Ophtalmicus](https://reader030.vdocuments.pub/reader030/viewer/2022020506/56d6be441a28ab3016915bef/html5/thumbnails/12.jpg)
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