Posted in Volume 15 - Number 4 Suppl
PARTAB RAI, SYED IMTIAZ ALI SHAH, SYED AFTAB HUSSAIN SHAH, ABDUL MANAN BHTTO, AZIZULLAH JALBANI, IMDAD ANSARI
ABSTRACT | Full Text PDF
PURPOSE OF STUDY: To discuss presentation, risk factors and outcome of patients with herpes zoster ophthalmicus.
DESIGN OF STUDY: Hospital based prospective study.
DURATION OF STUDY: From September 2001 to date.
PLACE OF STUDY: Department of Ophthalmology, Chandka Medical College Hospital Larkana.
MATERIAL AND METHODS: Our study included evaluation of 33 patients of herpes zoster ophthalmicus (HZO). From eye out patient department, all patients were admitted in the eye ward, where a specific proforma containing informed consent, patient’s bio data, history, clinical examination, investigations, treatment, and follow up was filled .In each case, as the diagnosis of HZO was usually apparent from their clinical features, therefore we have not performed laboratory tests to confirm the diagnosis of the disease. The underlying risk factors were find out by history, compatible eye, general / systemic clinical examination and relevant investigations where necessary. After ruling out risk factor, the ocular treatment was advised by ophthalmolo- gist and to treat underlying risk factors, the patients were referred to relevant specialist. Where necessary, the patients were treated with systemic and /or topical antibiotics, antiviral, corticosteroids, analgesics and anxiolytics. The follow-up of the patient was carried out for at least 5 years. Only cases of HZO were included in this study.
RESULTS: Our study included 33 cases of HZO, 24 (72.72%) men, and 9 (27.27%) women with age range 9 years to 68 years. The disease was on the left side in 18 (54.54%) cases and on the right side in 15(45.45%) cases.13 (39.39%) cases were presented within first 3 days of onset of skin rashes and 20 (60.60%) cases in 5-7 days of infection. All patients presented with low- grade fever, fatigue, malaise, headache, unilateral skin rashes with moderate to severe pain, oedema over the forehead, and eye lids. In 21 (63.63%) cases the ocular complaints were eye pain, redness, photophobia, and dimness of vision. The eye examination showed blephro- conjunctivitis in 10 (30.30%) cases, petechial subconjunctival haemorrhages 4 (12.12%) cases, punctate epithelial keratitis 7 (21.21%) cases, dendritic keratitis 5 (15.15%) cases, anterior stromal keratitis 3 (9.09%) cases, anterior uveitis 2(6.06%) cases. episcleritis 1(3.03%) cases, and scleritis 1(3.03%) case. 13 (39.39 %) cases presented within first 3 days of onset of HZO skin rashes were treated by oral acyclovir 800 mg 5 times a day for 7 days and 15 (45.45%) cases with keratits by topical acyclovir eye ointment 3% 5 times a day for 7-15 days. The late complications seen were deep stromal keratitis 2 (6.06%) cases, neurotrophic keratitis 2 (6.06%)cases, secondary inflammatory glaucoma 2 (6.06%) cases, secondary complicated cataract 2 (6.06%) cases, post herpetic neuralgia 2(6.06%) cases, oculomotor nerve palsy 2(6.06%) cases and abducent nerve palsy 1(3.03%) case.
CONCLUSION: Early presentation of patient will result in decreased risk of disease extension, and serious ocular sequelae like corneal scarring/vasculerization /perforation, secondary cataract /glaucoma, visual loss, and disabling pain.
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