Herpes Zoster Ophthalmicus (HZO)

Herpes Zoster Ophthalmicus (HZO)
SYMPTOMS Photophobia | Blurry vision | Pain | Malaise
SIGNS Stromal edema | Neovascularization | Stromal infiltrates | Pseudodendrite | Possible high IOP | Vesicular skin rash respecting the midline | Possible Hutchinson sign
WORK-UP Thorough history. Slit lamp examination
TREATMENT
Oral antivirals: Acyclovir 800 mg 5x/day x 7-10 days | Valacyclovir 1000 mg tid x 7-10 days | Famciclovir 500 mg tid x 7-10 days
Topical steroids (will require a long taper schedule): Pred Forte 1% 1 gtt q2h-q6h | Lotemax 1 gtt q2h-q6h
Topical cycloplegics may be used (cyclopentolate 1% 1 gtt tid)
** Use oral, not topical, antivirals in the treatment of zoster **
FOLLOW-UP Every 1-4 days
ADDITIONAL LAB | TESTS None
ETIOLOGY Varicella-zoster virus
DIFFERENTIAL DX Herpes simplex keratitis | Acanthamoeba keratitis | Recurrent corneal erosion
NOTES HZO is commonly known as shingles | After resolution, consider prophylactic oral antiviral use present/reduce subsequent episodes | Topical steroids should be tapered slowly

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