Fano MY, Estrada AYC

Language: Spanish
References: 15
Page: 43-48
PDF size: 90.35 Kb.

ABSTRACT

Introduction: the initial infection by the virus of the varicella-zoster produces an exanthematous acute illness (varicella). A few months later the herpes zoster is developed because of a reactivation of the latent endogenous virus. The area innervated by the trigeminal nerve is the second taking in consideration its frequency. When the illness affects the first branch of the nerve, receives the name ophthalmic herpes zoster and it is very important because it is very dangerous for the eye.
Objective: to show the clinical manifestations evidence, complications and ophthalmic sequels in a patient with an ophthalmic herpes zoster diagnosis.
Case Presentation: a male patient of 75 years old with personal medical records of varicella in the childhood, he goes to outpatient service because of lacrimation, photophobia and great palpebral edema in his right eye, accompanied by clear watery vesicles and scabs in skin of the forehead and nose. The ophthalmic exam evidences severe ciliary and conjunctival injection, dendritic keratitis, corneal endothelial plaques and positive Hutchinson's sign. It was diagnosed as complicated herpes zoster ophthalmicus with acute uveitis that left as a sequel a neurotropic keratitis and dry eyes. It was indicated, previous information to the patient, treatment with acyclovir, prednisolone, homatropin, artificial tears and multivitamins. It was carried out the differential diagnosis with illnesses that affect skin and mucous, especially the conjunctive one, with lesions to blister as cicatrizal pemphigoid, Stevens-Johnson syndrome and herpes simplex keratitis.
Conclusions: the herpes zoster ophthalmicus is an important cause of ocular morbidity due to the sequels like the neurotropic keratitis and dry eyes, with the consequent damage to the ocular surface.

REFERENCES

1. Montoro Cardoso E, Suárez Moreno O, Valdivia Álvarez JA. Micobacterias. En: Llop Hernández A, Valdés-Dapena, Vivanco MM, Zuazo Silva J. Microbiología y parasitología médicas. La Habana: Editorial Ciencias Médicas; 2006, p. 363-85.

2. López Villaescusa MT, Martínez Martínez ML, Faura Berruga C, Pérez García L. Herpes Zoster diseminado. Rev Clin Med Fam [revista en la Internet]. 2012 Feb; 5(1): 64-66. [Citado 2014 Nov 26]. Disponible en: http://scielo.isciii.es/ scielo.php?script=sci_arttext&pid=S1699-695X2012000100012&lng=es. http://dx.doi.org/10.4321/S1699-695X2012000100012.

3. Kim BJ, Seo YJ, Park JK, Lee JH. Complete ophthalmoplegia after herpes zoster. Clinical and Experimental Dermatology. 2007;32(2):162-4.

4. Manual Merck. Tratado de Medicina. 11na ed. Cap. 61; 2008.

5. Dorronzoro Ramírez, E. CORNEA: Fundamentals Diagnosis and Management. Arch Soc Esp Oftalmol. Ene 2012;87(1):25.

6. Hwang CW Jr, Steigleman WA, Saucedo-Sánchez E, Tuli SS. Reactivation of Herpes Zoster keratitis in na adult after varicella zoster vaccination. Cornea. 2012 nov 26.

7. Aldaz P, Díaz JA, Loayssa JR, Dronda MJ, Osacáriz M, Castilla J. Incidencia de Herpes Zoster en pacientes diabéticos. Anales Sis San Navarra [revista en la Internet]. 2013 Abr; 36(1): 57-62. [Citado 2014 Nov 26]. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1137- 66272013000100006&lng=es. http://dx.doi.org/10.4321/S1137- 66272013000100006.

8. Tseng SC, Tsubota K. Important concepts for treating ocular surface and tear disorders. Am J Ophthalmol. 1997; 124(4). [Citado 2010 ene 15]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/9402829

9. Bonini S, Rama P, Olzi D, Lambiase A. Neurotrophic keratitis. Eye. 2003; 17:989-95.

10. Sedó S, Torras J. La superficie ocular (2ª parte). Annals d´Oftalmologia. 2001;9(4). [Citado 2010 ene 15]. Disponible en: http://www.nexusediciones.com/ pdf/ao2001_4/of-9-3-002.pdf

11. Rueda OL, Roberto AS, Bolívar MA, Calvo B, Lauren S. Parálisis Parcial del Nervio Oculomotor Secundaria a Zoster Sine Herpete: Reporte de un Caso. Rev. Univ. Ind. Santander. Salud [revista en la Internet]. 2013 Dic; 45(3): 77-80. [Citado 2014 Nov 26]. Disponible en: http://www.scielo.org.co/ scielo.php?script=sci_arttext&pid=S0121-08072013000300008&lng=es.

12. Matsumoto Y, Dogru M, Goto E, Ohashi Y, Kojima T, Ishida R, Tsubota K. Autologous serum application in the treatment of neurotrophic keratopathy. Ophthalmology. 2004;111(6):1115-20.

13. Ortuño-Prados VJ, Alio JL. Tratamiento de úlcera corneal neurotrófica con plasma rico en plaquetas y Tutopatch®. Arch Soc Esp Oftalmol. Abr. 2011; 86(4):121-123.

14. Capella MJ, Álvarez de Toledo J, Paz MF. De la Insuficiencia limbar secundaria a múltiples inyecciones intravítreas. Arch Soc Esp Oftalmol. Mar 2011;86(3):89-92.

15. Quinto GG, Camacho W, Behrens A. Postrefractive surgery dry eye. Curr Opin Ophthalmol. 2008;19(4):335-41.