RESUMEN
Reactivation of herpes zoster ophthalmicus (HZO) can present as corneal involvement without any precedent neuralgia or characteristic herpetic rash. This form of HZO can be the first manifestation of reactivation of varicella zoster virus and can masquerade as peripheral ulcerative keratitis. A 45-year-old male treated for necrotizing fasciitis (NF) one month back presented with painful diminution of vision in the right eye (RE) for two weeks without any associated vesicular rash or neuralgia. On examination, best-corrected visual acuity in RE was 2/60 with non-marginal upper lid defect, and multiple linear contracture scars involving the upper lid, right temple, and preauricular region. There were associated peripheral corneal ring infiltrates, disc-shaped central stromal edema, and reduced corneal sensation. The patient had a history of chicken pox in childhood and was recently diagnosed with seropositive rheumatoid arthritis (RA). Though corneal scrapings were negative on Tzanck smear, a presumptive clinical diagnosis of herpetic disciform keratitis was made, and the patient was started on oral and topical acyclovir with steroids. This was confirmed with improving clinical course and detection of herpes zoster DNA on polymerase chain reaction from corneal scrapings. Lid reconstruction for associated lid defect was performed using paramedian forehead flap, which was remodeled at 16 weeks. Our case, a seropositive RA patient, had reactivation of varicella zoster manifesting as peripheral serpiginous and disciform keratitis activated after NF. There are a few case reports of periorbital NF following HZO in immunocompromised patients. However, till date, no case of HZO occurring after periorbital NF has been reported. Also, in our case, reactivation of HZO presented as disciform and serpiginous keratitis without any precedent herpetic rash or neuralgia.
RESUMEN
Purpose: To report a novel case of unilateral peripheral facial nerve palsy manifesting as a complication of Herpes simplex keratitis. Observations: A 51-year-old immunocompetent male presented with severe eye pain for 3 weeks. He was found to have Herpes simplex keratitis in the left eye and started on valacyclovir 3g per day for 10 days. At three weeks his pain and blurred vision resolved. He returned 2.5 months later with worsening of vision and five days of unilateral facial numbness and weakness. Ocular evaluation revealed a visual acuity of 20/25 in the left eye, which showed mid-stromal corneal edema bordered by several keratoprecipitates. Both the keratitis and Bell's palsy markedly improved with valacyclovir, topical prednisolone, and a 10-day course of oral prednisone. Conclusions and Importance: This is the first reported case of Bell's palsy accompanying disciform keratitis. Both entities have been observed to be caused by Herpes simplex, however they have not been described together in one patient. Knowledge that these conditions may present simultaneously allows for earlier identification and treatment, resulting in decreased morbidity.
RESUMEN
Simultaneously occurring bilateral herpetic keratitis is a rare clinical manifestation of ocular herpes. Immunocompromised patients are more susceptible to develop bilateral disease. The purpose of this study is to review recent literature on the topic and to highlight latest updates, regarding risk factors and possible correlations to the disease, as well as new therapeutic options.
RESUMEN
PURPOSE: We aimed to analyze the clinical features of herpetic endotheliitis and to investigate the risk factors for recurrence of herpetic endotheliitis and corneal decompensation. METHODS: The medical records of 58 patients (58 eyes) who were diagnosed with herpetic endotheliitis were retrospectively reviewed. Patients with a follow-up period of less than 6 months and a previous history of ocular inflammation were excluded from this study. We recorded visual acuity, intraocular pressure, central corneal thickness, and endothelial cell density on both initial and final visit, and recorded clinical findings of the anterior and posterior segments of the eye only on initial visit. Factors affecting the recurrence of herpetic endotheliitis and corneal decompensation were also analyzed. RESULTS: Among the 58 patients, 45 patients had disciform type endotheliitis, 11 patients had diffuse type, and 2 patients had linear type. There were no significant differences between final clinical manifestations according to subtype. 14 patients exhibited recurrence of herpetic endotheliitis. High intraocular pressure and high-grade anterior chamber cells were associated with the recurrence of herpetic endotheliitis. On multivariate analysis, the only risk factor for the recurrence of herpetic endotheliitis was high intraocular pressure. We found that 8 patients exhibited corneal decompensation, and high intraocular pressure, high anterior chamber cell grade, and a history of cataract surgery were associated with corneal decompensation. On multivariate analysis, the risk factors for corneal decompensation were high anterior chamber cell grade and cataract surgery history. CONCLUSIONS: For herpetic endotheliitis, the subtype did not affect the final records of clinical manifestation, and the only risk factor for the recurrence of herpetic endotheliitis was high intraocular pressure. Additionally, the risk factors of corneal decompensation were found to be high-grade anterior chamber cells and a history of cataract surgery. Initial examinations of clinical manifestation are important for the successful treatment of herpetic endotheliitis.