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