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