10/10 pain and worsening blurry vision in left eye for two weeks
Denies exposure to swimming pools, hot tubs, lakes, trauma, foreign body or contact lens wear
Seen three months ago for similar complaints found to have dendrites in left eye concerning for HSV, was treated with acyclovir and steroids with mild improvement
VA: 20/50, HM
Pupils equal round and reactive, no RAPD
EOM: full OU
SLE OS: linear branching dendritiform lesion with raised borders extending across entire surface of cornea with weak fluorescein staining
Herpes simplex keratitis
Herpes zoster ophthalmicus
Recurrent corneal erosion
HSV/VZV PCR negative
Wound culture negative
Herpes Zoster Ophthalmicus
Reactivation of latent varicella zoster virus
Associated with aging, impaired immunity, trauma, psychological stress
Prognosis and Future Directions
Herpes zoster ophthalmicus may be preceded by headache, fever, skin vesicles in a dermatomal distribution. Patients often complain of severe eye pain. It’s critical to distinguish HZO from other disease entities based on appearance alone as often times there is no skin findings and DNA PCR may be negative. HZO, when involving the epithelium, is an inflammatory process rather than an infectious one; therefore, the dendritiform lesions are not true ulcers and appear as elevated and not excavated. As such the mainstay of treatment is topical steroids and not topical antivirals which may prevent epithelium healing.
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