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Herpes Zoster Keratitis

What is Herpes Zoster Keratitis?

  • Herpes Zoster Keratitis is an outbreak of rash or blisters on the skin that is caused by the same virus that causes chickenpox.

  • If the outbreak begins on the forehead or nose, it is likely to spread to the eyes.

What are the symptoms or Herpes Zoster?

  • Skin rash

  • Skin discomfort

  • Paresthesias

  • Headache

  • Fever

  • Malaise

  • Blurred vision

  • Eye pain

  • Red eye (may precede the skin rash)

How is Herpes Zoster detected?

  • The patient’s eye doctor will do a complete ocular examination, including a slit-lamp evaluation with fluorescein staining, intraocular pressure check, and dilated optic nerve and retinal examination.

  • If patients are younger than 40 years old, a medical evaluation should be done to determine whether the patient may be immunocompromised.

How is Herpes Zoster treated?

  • Conjunctival involvement: Cool compresses and erythromycin ointment to the eye.

  • Corneal pseudodendrites or SPK: Lubrication with preservative-free artificial tears (e.g., Refresh Plus or Theratears) q 1 to 2 h and ointment (e.g., Refresh PM)

  • Immune stromal keratitis: Topical steroid (e.g., prednisolone acetate, 1%, q 1 to 6 h), tapering over months to years.

  • Uveitis (with or without immune stromal keratitis): Topical steroid (e.g., prednisolone acetate, 1%) q 1 to 6 h, cycloplegic (e.g., cyclopentolate, 1% to 2%, t.i.d.), and erythromycin ointment qhs.

  • Neurotrophic keratitis: Treat mild epithelial defects with erythromycin or preservative-free artificial tear ointment q.i.d. If corneal ulceration occurs, obtain appropriate smears and cultures to rule out infection.

  • Scleritis: Treat as any other scleritis

  • Retinitis, choroiditis, optic neuritis, or cranial-nerve palsy: Acyclovir, 5 to 10 mg/kg i.v., q 8 h for 1 week, and prednisone, 60 mg p.o., for 3 days, then tapering over 1 week.* Consider neurologic consultation to rule out CNS involvement.

What is the follow-up plan for Herpes Zoster Keratitis?

  • If ocular involvement is present, examine the patient every one to seven days, depending on the severity.

  • Patients without ocular involvement can be followed up every one to four weeks.  After the acute episode resolves, check the patient every three to six months, because relapses may occur months to years later, particularly as steroids are tapered.  Systemic steroid administration requires collaboration with the patient’s medical doctor.

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