RESUMO
A 15-year-old boy was referred for corneal opacity evaluation. The patient had a previous herpes zoster virus (HZV) infection-varicella-zoster virus (VZV)-with ocular manifestation 1 year ago. After the infection, he developed a central corneal scar and decreased corrected distance visual acuity (CDVA) in the right eye. The slitlamp examination showed the right eye with central corneal opacity (involving anterior stroma), lacuna area between the haze, fluorescein negative, and no vascularization near the scar (Figure 1JOURNAL/jcrs/04.03/02158034-202406000-00019/figure1/v/2024-07-10T174224Z/r/image-tiff). The patient had been treated with oral valacyclovir and topical corticosteroids without any improvement of visual acuity or changes in opacity within the 1-year follow-up. His CDVA was 20/200 (-4.50 -0.75 × 25) in the right eye and counting fingers (-4.00) in the left eye. Intraocular pressure was 12 mm Hg in both eyes. Fundoscopy was normal in the right eye, but he had a macular scar in the left eye (diagnosed when he was 7 years). The left eye had no cornea signs. The patient has no comorbidity or previous surgeries. Considering this case, a corneal central scar in a 15-year-old boy, legally single eye only, and assuming it is an opacity in the anterior stroma, would you consider surgery for this patient? If so, which would you choose: Would you consider an excimer laser treatment of his ametropia while partially removing his opacity, a phototherapeutic keratectomy (PTK), or a PTK followed by a topography-guided treatment, femtosecond laser-assisted anterior lamellar keratoplasty (FALK), or deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (depending on the scar depth)? Would you consider prophylactic acyclovir during and after surgery? Would you consider any other surgical step to prevent delayed corneal healing-persistent epithelial defect? Before the surgical approach, would you consider treating this patient with topical losartan (a transforming growth factor [TGF]-ß signaling inhibitor)? Would you first perform the surgery (which one) and then start the medication? Furthermore, if so, how long would you treat this patient? Would you consider treatment with another medication?
Assuntos
Opacidade da Córnea , Herpes Zoster Oftálmico , Acuidade Visual , Humanos , Masculino , Opacidade da Córnea/diagnóstico , Opacidade da Córnea/etiologia , Opacidade da Córnea/tratamento farmacológico , Adolescente , Acuidade Visual/fisiologia , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/diagnóstico , Herpes Zoster Oftálmico/virologia , Antivirais/uso terapêutico , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/virologia , Infecções Oculares Virais/tratamento farmacológico , Ceratoplastia PenetranteAssuntos
Herpes Zoster Oftálmico , Vasculite do Sistema Nervoso Central , Humanos , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/diagnóstico , Herpes Zoster Oftálmico/tratamento farmacológico , Vasculite do Sistema Nervoso Central/complicações , Vasculite do Sistema Nervoso Central/diagnóstico por imagemRESUMO
Herpes Zoster (HZ) is rare in childhood and is defined as the reactivation of the latent varicella-zoster virus in patients who have previously been infected with varicella. When the virus affects the ophthal mic nerve it is called herpes zoster ophthalmicus (HZO) and it can produce, among other symptoms, acute headache, so it must be considered as a differential diagnosis. OBJECTIVE: To describe a clinical case of HZO in a pediatric patient and to recognize its clinical manifestations and their importance in the differential diagnosis of acute headache in children. CLINICAL CASE: Immunocompetent 11-year- old girl, vaccinated according to the recommended immunization schedule, excluding chickenpox vaccine due to past infection, presented to the emergency department (ED) with a 5-day long uni lateral headache. After 36 hours of hospitalization, she presented vesicular cutaneous lesions in her forehead, left upper eyelid, and nose. Positive fluorescein stain dendritic corneal lesions were iden tified in the ophthalmic exam. Antiviral systemic and topic therapy were set, obtaining an initial good response, but later she presented complications such as postherpetic neuralgia one month after hospital discharge and several postherpetic neuralgia episodes despite treatment with gabapentin in addition to two herpes zoster ophthalmicus relapses with acute keratouveitis one year after the initial episode. CONCLUSION: It is essential to include HZO in the differential diagnosis of acute headache, especially when presented unilaterally and/or with ocular symptoms, regardless of the presence of cutaneous lesions, and even more so in patients with history of chickenpox infection. Those patients who were vaccinated against this disease in their childhood will benefit from at least partial protection against HZO.
Assuntos
Varicela , Herpes Zoster Oftálmico , Neuralgia Pós-Herpética , Varicela/complicações , Criança , Feminino , Cefaleia/complicações , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/diagnóstico , Herpes Zoster Oftálmico/tratamento farmacológico , Herpesvirus Humano 3/fisiologia , Humanos , Neuralgia Pós-Herpética/complicaçõesRESUMO
OBJECTIVES: This study aimed to estimate the prevalence of Herpes Zoster Ophthalmicus (HZO) and describe the sociodemographic disease distribution by age, sex, and region in Colombia using National Health Registry data between January 1, 2015, to December 31, 2019. METHODS: We conducted a cross-sectional study using the Integrated Social Protection Information System database from the Colombian Ministry of Health, the unique official database in the country. We used the specific code of the International Classification of Diseases for HZO (B02.3) from 2015-2019 to estimate the prevalence and the demographic status of the disease in Colombia. RESULTS: The average prevalence was 0.99 in 100,000 inhabitants. Females represented 54.44% of the cases from 2,378 included patients. The distribution by age has a continual increase from the quinquennial group of 55 years. The geographic analysis shows a higher disease burden in the Andean region, followed by the Caribbean and Pacific regions. CONCLUSION: This is the first study that determines the HZO epidemiological characteristics based on a National Health database in our region. We found an age distribution similar to previous studies and suggest that higher altitudes correlate with a higher burden of the disease.
Assuntos
Herpes Zoster Oftálmico , Colômbia/epidemiologia , Estudos Transversais , Feminino , Herpes Zoster Oftálmico/epidemiologia , Humanos , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
RESUMEN El herpes zoster oftálmico es la infección producida por el virus varicela zoster (culebrilla) que afecta el ojo; se caracteriza por exantema en el dermatoma de la frente e inflamación dolorosa de todos los tejidos del segmento anterior, rara vez del posterior. Se presentó un paciente de 64 años de edad, raza blanca, con un herpes zoster oftálmico que le causaba dolor agudo. Las lesiones vesiculosas deformaron la mitad izquierda de su cara. El terapeuta empleó la acupuntura como método de tratamiento y se le colocaron agujas en los puntos IG-4 (Hegu) e IG-11 (Quchi) bilateral; en el proceso se colocó al paciente en posición decúbito supino con sesiones de media hora y estimulación cada cinco minutos de las agujas, de forma sedativa. Se apreció la reducción de la intensidad del dolor desde el primer día y la curación de las lesiones a los seis días de tratamiento.
ABSTRACT Herpes zoster ophthalmicus is the infection caused by the varicella-zoster virus (shingles) that affects the eye; it is characterized by rash in a dermatomal distribution of the forehead and painful inflammation of all the tissues of the anterior segment, rarely of the posterior one. A 64-year-old white patient was presented with a herpes zoster ophthalmicus causing acute pain. Vesicular lesions deformed the left half of his face. The therapist used acupuncture as a treatment method and placed needles in points IG-4 (Hegu) and bilateral IG-11 (Quchi); the patient was placed in supine position during the process, with half-hour sessions and stimulation of the needles every five minutes, in a sedative form. A reduction in pain intensity was appreciated from the first day, as well as, the healing of the lesions after six days of treatment.
Assuntos
Herpes Zoster Oftálmico , Terapia por AcupunturaRESUMO
ABSTRACT Objective: Herpes Zoster Ophthalmicus (HZO) is caused by varicella-zoster virus (VZV) and commonly affects elderly or immunocompromised patients. It has the potential to generate severe complications such as corneal ulcers, uveitis, retinal necrosis and post herpetic neuralgia. This study aimed to evaluate patients at the acute onset of the disease and describe their clinical profile and ophthalmologic findings. Methods: A cross-sectional study was performed from March 2014 to October 2015. All consecutive patients with the diagnosis of acute HZO (at a vesicle, pustule or crust stage) were enrolled and submitted to an ophthalmologic exam that included ectoscopy, best corrected visual acuity, corneal sensitivity test, slit-lamp examination, Goldmann applanation tonometry and funduscopic examination. Results: Nineteen patients were included. The mean age was 71 years old, ranging from 52 to 88. Ten patients had high blood pressure (52.6%) and nine (47.3%) had diabetes. Visual acuity lowered in comparison to the fellow eye in eleven patients (57%), ranging from one to six lines of vision, due mostly to epithelial keratitis and ocular discharge. Intraocular pressure (IOP) did not varied in most cases compared to the fellow eye. Hutchinson's sign (HS) was present in seven (36%) patients. The correlation between HS and anterior chamber reaction as well as decreased corneal sensitivity was statistically significant with Fisher's test of 0.009 and 0.029 respectively (p<0.05). Conclusion: The clinical profile of our patients was elderly patients with a higher rate of diabetes. Correlation between Hutchinson's sign and anterior chamber reaction as well as decrease in corneal sensitivity was significant. High intraocular pressure or posterior segment complications were not found in any cases.
RESUMO Objetivos: Herpes Zoster Oftálmico (HZO) é uma doença causada pelo vírus varicella-zoster que comumente afeta idosos ou doentes imunossuprimidos, com potencial para gerar graves comorbidades oculares, incluindo úlceras corneanas, uveíte, necrose retiniana e neuralgia pós-herpética. O objetivo deste estudo foi avaliar estes pacientes na forma aguda da doença e descrever seu perfil clínico e achados oftalmológicos. Métodos: Um estudo transversal foi realizado entre março de 2014 e outubro de 2015. Todos os pacientes consecutivos com o diagnóstico de HZO (na forma vesicular, pustulosa ou crostosa) foram incluídos e submetidos ao exame oftalmológico que incluiu ectoscopia, melhor acuidade visual corrigida, teste de sensibilidade corneana, biomicroscopia, tonometria de aplanação de Goldmann e fundoscopia. Resultados: Dezenove pacientes foram incluídos. A idade média foi de 71 anos. Dez (52,6%) pacientes relataram hipertensão arterial sistêmica e nove (47,3%) diabetes mellitus. A acuidade visual do olho acometido se encontrou abaixo do olho contra lateral em 57% dos casos, variando entre uma a seis linhas de visão. A pressão intraocular não variou na maioria dos casos em comparação com o olho contralateral. O sinal de Hutchinson estava presente em sete (36%) pacientes. A correlação entre este sinal e a presença tanto de reação de câmara anterior quanto de hipoestesia corneana foi positiva estatisticamente, com teste exato de Fisher de 0,009 e 0,029 respectivamente (p<0,05). Conclusão: Idosos com uma prevalência elevada de diabetes mellitus representaram o perfil clínico dos pacientes deste estudo. A correlação entre o sinal de Hutchinson e reação de câmara anterior, bem como daquele com hipoestesia corneana foi estatisticamente significativa. Não foi identificado nenhum caso de hipertensão ocular ou complicações de segmento posterior.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/diagnóstico , Uveíte/etiologia , Comorbidade , Estudos Transversais , Diabetes Mellitus , Técnicas de Diagnóstico Oftalmológico , Hipertensão , Ceratite/etiologiaRESUMO
Herpes zoster (HZ) corresponds to the reactivation of varicella zoster virus (VZV). Among adults, the ophthalmic division of the trigeminal nerve is one of the most common sites of involvement. Vasculopathy caused by HZ is associated with significant morbidity and mortality, affecting structures such as the brain, which can lead to stroke. In this review, we analyzed the epidemiological and clinical aspects of the vascular involvement of VZV, focusing on the peculiarities of its association with ocular HZ. A review of the available literature indicated that ocular involvement of HZ was a risk factor for vasculopathy after adjusting for age, sex, body mass index, smoking, indicators of metabolic syndrome, and vascular and heart diseases. Considering the severity of this complication, vascular disease mediated by VZV requires early diagnosis and aggressive treatment. Finally, the anti-HZ vaccine has been recommended as a prophylactic measure in the elderly, but it should be used with caution in immunocompromised individuals.
Assuntos
Herpes Zoster Oftálmico/fisiopatologia , Herpesvirus Humano 3/fisiologia , Doenças Vasculares/virologia , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/terapia , Humanos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/virologia , Doenças Vasculares/complicaçõesRESUMO
ABSTRACT Herpes zoster (HZ) corresponds to the reactivation of varicella zoster virus (VZV). Among adults, the ophthalmic division of the trigeminal nerve is one of the most common sites of involvement. Vasculopathy caused by HZ is associated with significant morbidity and mortality, affecting structures such as the brain, which can lead to stroke. In this review, we analyzed the epidemiological and clinical aspects of the vascular involvement of VZV, focusing on the peculiarities of its association with ocular HZ. A review of the available literature indicated that ocular involvement of HZ was a risk factor for vasculopathy after adjusting for age, sex, body mass index, smoking, indicators of metabolic syndrome, and vascular and heart diseases. Considering the severity of this complication, vascular disease mediated by VZV requires early diagnosis and aggressive treatment. Finally, the anti-HZ vaccine has been recommended as a prophylactic measure in the elderly, but it should be used with caution in immunocompromised individuals.
RESUMO Herpes zoster (HZ) corresponde à reativação do vírus varicela zoster (VVZ) e, entre os adultos, o envolvimento da divisão oftálmica do nervo trigêmeo é um dos locais mais comuns A vasculopatia associada ao HZ é uma complicação dotada de grande morbimortalidade e afeta diferentes estruturas, favorecendo, inclusive o acidente vascular cerebral. Nesta revisão analisamos aspectos epidemiológicos e clínicos da vasculopatia mediada pelo VZV, bem como as peculiaridades relacionadas com o HZ ocular. De acordo com dados disponíveis na literatura, o acometimento ocular pelo HZ mostrou ser um fator de risco para vasculopatia após se ajustar para idade, sexo, índice de massa corporal, tabagismo, indicadores da síndrome metabólica, doença vascular e cardiopatias. Em face da gravidade dessa complicação, a doença vascular mediada pelo VZV requer diagnóstico precoce e tratamento agressivo. A vacina anti-HZ tem sido recomendada profilaticamente em idosos, mas deve ser usada com cautela em indivíduos imunocomprometidos.
Assuntos
Humanos , Doenças Vasculares/virologia , Herpes Zoster Oftálmico/fisiopatologia , Herpesvirus Humano 3/fisiologia , Doenças Vasculares/complicações , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/terapia , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/virologiaRESUMO
Introducción: el herpes zoster oftálmico se ha incrementado a nivel mundial y Cuba no es la excepción, debido al mejor conocimiento de la infección e incremento de la edad media poblacional. Pero existen diversas formas de presentación, así como tratamientos no basado en evidencias clínicas, lo que ha conllevado a complicaciones.Objetivo: determinar las características clínico-epidemiológicas y tratamiento indicado en los pacientes con herpes zoster oftálmico.Métodos: se realizó un estudio observacional descriptivo de corte transversal, en el Hospital General Docente Aleida Fernández Chardiet. Güines. Mayabeque, desde enero de 2012 hasta diciembre de 2013. El universo estuvo constituido por 58 pacientes con diagnóstico de herpes zoster. La muestra incluyó a 40 pacientes con criterios de inclusión. Se caracterizaron los pacientes según variables demográficas. Se analizaron condiciones asociadas, forma de presentación, gravedad de la erupción cutánea, complicaciones oculares y tratamiento indicado. Resultados: el 85 por ciento de la muestra presentaba algún factor de riesgo, siendo la edad mayor de 70 años el más encontrado, predominó las formas de presentaciones típicas de la enfermedad 77,5 por ciento. Se encontró aumento de las complicaciones oculares relacionadas con la gravedad de las erupciones cutáneas 40 por ciento y con un pobre o ausente tratamiento antiviral 65 por ciento.Conclusiones: predominó en los pacientes mayores de 70 años, sexo femenino, y no hubo diferencia en cuanto al color de la piel, coincidiendo con la literatura revisada. Elevado número de pacientes que no recibieron el tratamiento antiviral y se asocian a complicaciones oculares (AU)
ophthalmologic herpes zoster has increased all over the world and Cuba is not an exception, because of a better knowledge of the infection and the growing of the age rate of the population. But there are several ways of presentation, as well as treatments non based on clinical evidences, so complications have appeared Objective: to determine the clinical epidemiological characteristics and indicated treatment in patients with ophthalmologic herpes zoster.Methods: a transversal descriptive observational study was performed at Aleida Fernandez Chardiet Teaching General Hospital in Güines, Mayabeque, from January 2012 to December 2013. The universe was formed by 58 patients with the diagnosis of herpes zoster. The sample included 40 patients with inclusion criteria. The patients were characterized according to demographic variables. Associated conditions, way of presentation, status of the cutaneous rash, ocular complications and indicated treatment were analyzed. Results: the 85 per cent of the sample presented certain risk factor, age, higher than 70 years old was the most common, typical ways of presentation of the disease prevailed 77,5 per cent. Increasing of ocular complications related to the conditions of the cutaneous rashes was showed 40 per cent and a poor or absent antiviral treatment 65 per cent.Conclusions: patients older than 70 years old prevailed, female sex, and there was no difference in the color of the skin, it coincides with the consulted literature. There is a high number of patients who did not receive antiviral treatment and they are associated to ocular complications. Key words: herpes zoster ophthalmicus; acyclovir; aged (AU)
Assuntos
Herpes Zoster Oftálmico , Aciclovir , IdosoRESUMO
CLINICAL CASES: Several treatments have been described for the management of patients with herpes zoster ophthalmicus (HZO). However, the progress of these patients is usually slow, and many of them develop postherpetic neuritis (PHN). In the present paper, three clinical cases are presented, in which a significant symptomatic improvement was obtained by using a preauricular injection of a mixture of betamethasone depot combined with acyclovir. PHN did not develop in any of them. DISCUSSION: The preauricular injection of betamethasone depot and acyclovir could be a good alternative for the management of HZO.
Assuntos
Aciclovir/administração & dosagem , Antivirais/administração & dosagem , Betametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Herpes Zoster Oftálmico/tratamento farmacológico , Doença Aguda , Idoso , Preparações de Ação Retardada , Quimioterapia Combinada , Orelha , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-IdadeRESUMO
A 58-year-old woman presented with rash over the left side of the face and intense acute uveitis. Following careful review of the symptoms and dilated fundus examination unilateral optic neuritis was discovered. The rash was typical of varicella zoster dermatitis. Patients presenting with herpes zoster ophthalmicus should always undergo dilated fundus examination, as there is a potential risk of unexpected posterior segment inflammation. Early diagnosis and prompt treatment can avoid visual sequelae.
Paciente de 58 anos de idade apresentando erupção cutânea no lado esquerdo da face e intensa uveíte unilateral. Após cuidadosa revisão dos sintomas e exame de fundo do olho foi detectada neurite óptica. O rash era típico de dermatite por varicella zoster. Pacientes apresentando quadro de herpes zoster oftálmico devem ser submetidos ao exame de fundo do olho devido ao risco de inesperada inflamação do segmento posterior. Diagnóstico precoce e tratamento imediato podem evitar danos visuais.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Varicela/complicações , Neurite Óptica/diagnóstico , Neurite Óptica/etiologia , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/diagnóstico , Herpesvirus Humano 3/imunologia , Nervo Óptico/patologia , Nervo Óptico/diagnóstico por imagem , Sulfonamidas/uso terapêutico , Timolol/uso terapêutico , Ativação Viral , Prednisona/uso terapêutico , Angiofluoresceinografia , Neurite Óptica/tratamento farmacológico , Neurite Óptica/virologia , Uveíte Anterior/diagnóstico , Uveíte Anterior/virologia , Hipertensão Ocular/etiologia , Hipertensão Ocular/tratamento farmacológico , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/virologia , Corticosteroides/uso terapêutico , Tomografia de Coerência Óptica , Microscopia com Lâmpada de Fenda , Valaciclovir/uso terapêutico , Fundo de Olho , Pressão Intraocular/fisiologia , Midriáticos/uso terapêuticoRESUMO
Herpes zoster (HZ) is an acute infection caused by reactivation of the latent varicella-zoster virus [1]. Herpes zoster ophthalmicus (HZO) occurs when inflammation spreads from the ganglion of Gasser to the ophthalmic branch of the trigeminal nerve. Optic neuritis, a very rare sequela of HZO [2-4], can occur simultaneously to the acute vesicular skin eruption or, more frequently, as a postherpetic complication. We report on a 74-year-old woman who presented with HZ optic neuritis 45 days after developing an incompletely treated bout of trigeminal HZ, characterized only by pruritus. It is important to value the non-specific manifestations of cutaneous HZ in the prodromal phase, so as to offer timely and appropriate treatment.
Assuntos
Herpes Zoster Oftálmico/diagnóstico , Nervo Óptico/patologia , Neurite Óptica/diagnóstico , Aciclovir/administração & dosagem , Idoso , Antivirais/administração & dosagem , Diagnóstico Diferencial , Potenciais Evocados Visuais , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/fisiopatologia , Humanos , Injeções Intravenosas , Neurite Óptica/tratamento farmacológico , Neurite Óptica/virologia , Acuidade VisualRESUMO
Se presentó el caso remitido a nuestro servicio de rehabilitación de la especialidad de oftalmología, con el diagnóstico de herpes zóster oftálmico, por presentar dolor y lesiones maculares, vesículas sobre una base eritematosa en la región periorbitaria y frontal derecha, acompañado de intenso edema. Tratado, además, en primera instancia, por dermatología con: aciclovir, antiinflamatorios (prednisona), vitaminoterapia y colirios. A los 7 días comenzó tratamiento de fisioterapia con radiación láser durante 15 sesiones, y continuó con 20 aplicaciones del campo magnético continuo, lo cual garantizó, con la interrelación de varias especialidades médicas y un enfoque multidisciplinario, la evolución satisfactoria del paciente(AU)
Present case was referred to our rehabilitation service of Ophthalmology specialty diagnosed with ophthalmic herpes zoster, pain and macular lesions, vesicles on an erythematous basis in right frontal periorbital region, accompanied of intense edema. The first treatment was applied in the Dermatology service with acyclovir, anti-inflammatory drugs (Prednisone), vitamin-therapy and eyedrops. At 17 days was treated with physiotherapy with laser radiation for 15 sessions continuing 20 applications of continuous magnetic field guarantying with the interrelation of some medical specialties and a multidisciplinary approach, the satisfactory evolution of patient(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Herpes Zoster Oftálmico/tratamento farmacológico , Terapia a Laser/métodos , Terapias ComplementaresRESUMO
Se presentó el caso remitido a nuestro servicio de rehabilitación de la especialidad de oftalmología, con el diagnóstico de herpes zóster oftálmico, por presentar dolor y lesiones maculares, vesículas sobre una base eritematosa en la región periorbitaria y frontal derecha, acompañado de intenso edema. Tratado, además, en primera instancia, por dermatología con: aciclovir, antiinflamatorios (prednisona), vitaminoterapia y colirios. A los 7 días comenzó tratamiento de fisioterapia con radiación láser durante 15 sesiones, y continuó con 20 aplicaciones del campo magnético continuo, lo cual garantizó, con la interrelación de varias especialidades médicas y un enfoque multidisciplinario, la evolución satisfactoria del paciente
Present case was referred to our rehabilitation service of Ophthalmology specialty diagnosed with ophthalmic herpes zoster, pain and macular lesions, vesicles on an erythematous basis in right frontal periorbital region, accompanied of intense edema. The first treatment was applied in the Dermatology service with acyclovir, anti-inflammatory drugs (Prednisone), vitamin-therapy and eyedrops. At 17 days was treated with physiotherapy with laser radiation for 15 sessions continuing 20 applications of continuous magnetic field guarantying with the interrelation of some medical specialties and a multidisciplinary approach, the satisfactory evolution of patient
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Terapias Complementares , Herpes Zoster Oftálmico/tratamento farmacológico , Terapia a Laser/métodosRESUMO
UNLABELLED: Scleritis are entities that may have rheumatic diseases, infections or tumors as etiologic factors or may be a disease restricted only to the eye. PURPOSE: To share a three year experience of a rheumato-ophthalmologic ambulatory in the diagnosis and treatment of patients with scleritis. METHODS: This was a study of 29 cases. All of them were analyzed by the Ophthalmology and Rheumatology Services. RESULTS: From the 29 cases, an underlying disease was found in 55.17%. Rheumatic diseases were present in 34.4%; infectious in 20.6%. Idiophatic forms of scleritis did not differ from the rheumatic ones although a higher number of necrotizing cases were seen in the later group (with no statistical significance). Scleritis due to rheumatic diseases was treated more frequently with oral corticosteroids and immunosuppressive drugs. CONCLUSIONS: Patients with scleritis have a high rate of infectious and rheumatic diseases. Cooperation of rheumatologists and ophthalmologists was useful for the etiologic identification of patients with scleritis.
Assuntos
Herpes Simples/complicações , Herpes Zoster Oftálmico/complicações , Hanseníase/complicações , Doenças Reumáticas/complicações , Esclerite/etiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerite/diagnóstico , Adulto JovemRESUMO
Esclerites são doenças que podem ter como causa uma doença reumatológica, infecciosa ou tumoral ou, ainda, ser uma entidade restrita apenas ao olho. Objetivo: Relatar a experiência de dois anos de um ambulatório conjunto de Reumato-Oftalmologia no diagnóstico e acompanhamento de pacientes com esclerite por três anos. Métodos: Esta é uma análise de 29 casos de esclerite. Todos os casos foram avaliados pelo serviço de Oftalmologia e pelo de Reumatologia. Resultados: Dos 29 casos identificados, foi possível identificar uma doença subjacente em 55,17 por cento dos casos. Observamos doenças reumáticas em 34,4 por cento e infecciosas 20,6 por cento dos casos. As esclerites idiopáticas não se distinguiram das reumáticas quanto às características clínicas embora um maior número de casos com a forma necrosante tenha sido visto nas reumáticas (sem significância estatística). Esclerites com doença reumática subjacente foram tratadas mais vezes com corticóides orais e imunossupressores. Conclusões: A cooperação entre reumatologistas e oftalmologistas se mostrou útil na identificação etiológica de pacientes com esclerite.
Scleritis are entities that may have rheumatic diseases, infections or tumors as etiologic factors or may be a disease restricted only to the eye. Purpose: To share a three year experience of a rheumato-ophthalmologic ambulatory in the diagnosis and treatment of patients with scleritis. Methods: This was a study of 29 cases. All of them were analyzed by the Ophthalmology and Rheumatology Services. Results: From the 29 cases, an underlying disease was found in 55.17 percent. Rheumatic diseases were present in 34.4 percent; infectious in 20.6 percent. Idiophatic forms of scleritis did not differ from the rheumatic ones although a higher number of necrotizing cases were seen in the later group (with no statistical significance). Scleritis due to rheumatic diseases was treated more frequently with oral corticosteroids and immunosuppressive drugs. Conclusions: Patients with scleritis have a high rate of infectious and rheumatic diseases. Cooperation of rheumatologists and ophthalmologists was useful for the etiologic identification of patients with scleritis.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Herpes Simples/complicações , Herpes Zoster Oftálmico/complicações , Hanseníase/complicações , Doenças Reumáticas/complicações , Esclerite/etiologia , Esclerite/diagnóstico , Adulto JovemRESUMO
Se trata de una paciente blanca, femenina, de 79 años, que en el curso de un herpes zoster oftálmico comienza con manifestaciones clínicas neurológicas, que se interpretaron inicialmente como reacciones adversas al tratamiento oral con aciclovir; siendo el sistema nervioso central la localización extracutánea más frecuente de este herpes virus; y la forma más común de afectación neurológica en esta infección es una encefalitis, se pensó en esta entidad a pesar de su atipicidad no reportada en la bibliografía consultada, lo que motivó a realizar una revisión exhaustiva de este tema. La paciente evolucionó satisfactoriamente con desaparición de los síntomas y signos clínicos...(AU)
It deals with a 79-years-old, white, female patient, beginning with neurological clinical manifestations in the course of ophthalmologic zoster herpes. Initially they were interpreted as adverse reactions of the acyclovir treatment. Being the central nervous centre the most frequent extra-cutaneous location of this herpes virus, and encephalitis the most common neurologic affection in this infection, we thought about this entity despite of its atypicity, which was not found in the consulted bibliography. It motivated us to make an exhaustive review of this theme. The evolution of the patient was positive, disappearing the clinic signs and symptoms...(AU)
Assuntos
Humanos , Feminino , Idoso , Herpes Zoster Oftálmico/diagnóstico , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/tratamento farmacológico , Encefalite por Varicela Zoster/etiologia , Encefalite por Varicela Zoster/diagnóstico , Encefalite por Varicela Zoster/tratamento farmacológico , Aciclovir , Aciclovir/efeitos adversos , Prednisona/uso terapêuticoRESUMO
Se trata de una paciente blanca, femenina, de 79 años, que en el curso de un herpes zoster oftálmico comienza con manifestaciones clínicas neurológicas, que se interpretaron inicialmente como reacciones adversas al tratamiento oral con aciclovir; siendo el sistema nervioso central la localización extracutánea más frecuente de este herpes virus; y la forma más común de afectación neurológica en esta infección es una encefalitis, se pensó en esta entidad a pesar de su atipicidad no reportada en la bibliografía consultada, lo que motivó a realizar una revisión exhaustiva de este tema. La paciente evolucionó satisfactoriamente con desaparición de los síntomas y signos clínicos.
It deals with a 79-years-old, white, female patient, beginning with neurological clinical manifestations in the course of ophthalmologic zoster herpes. Initially they were interpreted as adverse reactions of the acyclovir treatment. Being the central nervous centre the most frequent extra-cutaneous location of this herpes virus, and encephalitis the most common neurologic affection in this infection, we thought about this entity despite of its atypicity, which was not found in the consulted bibliography. It motivated us to make an exhaustive review of this theme. The evolution of the patient was positive, disappearing the clinic signs and symptoms.
Assuntos
Humanos , Feminino , Idoso , Encefalite por Varicela Zoster , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/diagnóstico , Herpes Zoster Oftálmico/tratamento farmacológico , Aciclovir/efeitos adversos , Aciclovir , Prednisona/uso terapêuticoRESUMO
OHerpes Zoster Oftálmico (HZO) decorre da infecção pelo vírus da varicela-zoster que permanece latente no gânglio de Gasser até que seja reativado e comprometa a divisão oftálmica do nervo trigêmeo. HZO freqüentemente causa manifestações oftalmológicas como lesões vesiculares palpebrais, ceratoconjuntivite, esclerite, uveíte, paralisia oculomotora, miosite orbitária e neurite óptica. Raramente o acometimento do ápice da órbita pode ser a manifestação inicial desta grave afecção. Este trabalho relata um caso de síndrome do ápice orbitário associado à meningite, causado por HZO e que foi tratado com corticosteróide e aciclovir sistêmicos.
Herpes Zoster ophthalmicus (HZO) is caused by a varicella-zoster virus infection which remains latent in the ganglion of Gasser until it is reactivated and compromise the ophthalmic division of the trigeminal nerve. HZO commonly causes neuro-ophthalmic complications such as vesicular lesions in the eyelids, keratoconjunctivitis, sclertis, uveitis, ocular palsy, orbital miositis and optic neuritis. HZO rarely presents as an orbital apex syndrome. This paper describes a patient with of orbital apex syndrome associate and meningitis caused by HZO which was treated with systemic steroids and acyclovir.