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   Table of Contents      
ARTICLE
Year : 1960  |  Volume : 8  |  Issue : 3  |  Page : 75-76

Herpes zoster ophthalmicus preceded by keratitis


Department of ophthalmology, All India Institute of Medical Sciences, New Delhi-16, India

Date of Web Publication5-May-2008

Correspondence Address:
L P Agarwal
Department of ophthalmology, All India Institute of Medical Sciences, New Delhi-16
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Agarwal L P, Malik S, Khosla P. Herpes zoster ophthalmicus preceded by keratitis. Indian J Ophthalmol 1960;8:75-6

How to cite this URL:
Agarwal L P, Malik S, Khosla P. Herpes zoster ophthalmicus preceded by keratitis. Indian J Ophthalmol [serial online] 1960 [cited 2019 Dec 12];8:75-6. Available from: http://www.ijo.in/text.asp?1960/8/3/75/40683

Herpes Zoster generally starts with severe neuralgia, followed by appearance of skin vesicles along the course of certain branches of 5 th nerve. It is observed most frequently on the inner half of the upper lid, the adjacent side of the nose , over the eyebrows and in the region of distribution of the supra-trochlear, the infratrochlear,super orbital and nasociliary nerves. The corneal involvement usually occurs a few days after skin vesicles have appeared. Eight cases, six cases by Edgerton(1942), one case by Thumin(1949) and abel and nadbath(1952) have been reported in the literature in which keratitis preceded the neuralgia and cutaneous lesion. We present a case in which keratitis appeared 7 days before the appearance of severe neuralgia.


  Detailed Report of the Case Top
(Female, 40 years)

Case history

The patient came on November 15 th 1959 with a dull pain in the eye. The following day there was severe neuralgic pain in the distribution area of supra-orbital, supra-trochlear and infratrochlear nerves. This was accompanied by vomiting, photophobia and lacrimation. Vision was reduced to 6/12 in the right eye. There was conjunctival and ciliary injection. On slit lamp examination small round white infiltrations taking fluorescein stain,involving the upper portion of cornea, more marked towards the limbus could make it out. Atropin 1 p.c and Chloromycetin occulum were applied locally. Pethidin 100 mgm and largactil 50mgm were administered intramuscularly. Largactil tablets 50mgm one twice a day and Luminal one half grain four times a day were given orally and 200cc glucose 25% was given intravenously. The condition did not improve in spite of treatment for five days, the vision dropping to 6/24.

On the 21 st , that is on the 6 th day erythema appeared along the distributuion of the orbital and trochlear nerves.The keratitis increased, involving the whole of the cornea. It was not possible to take the vision. A provisional diagnosis of herpes Zoster Ophthalmicus was made.

On the 22 nd , vesicles appeared along the course of the orbital nerves. Vomiting became less but photophobia, lacrimation and the ocular and facial conditions remained unchanged.Achromycin capsule(250mgm) one, six hourly were given orally.Dihydroergotamine tartarte 1 cc thrice daily were given intramuscularly.

In spite of all this treatment, the condition did not improve upto the 25 th . On the 25 th Achromycin was stopped-small-pox vaccination was done.

On the 26 th the neuralgia had become much less although the ocular and facial conditions remained unchanged.Dihydro-ergotamine and luminal were stopped.

By the 30 th the neuralgia had disappeared, the vesicles started to dry and cornea started getting clearer, the recorded vision being 6/18 on this day.

The condition kept on improving till she was discharged from the hos­pital on the 3rd of December when her vision had improved to 6/12.

On 16th December there was re­appearance of neuralgia along the orbital nerves, which was very severe.

This required for its relief nerve blocking with 10 cc of 2 per cent Xylocainc infiltration in the area of the neuralgia, repeated four times and dihydro-ergotamine tartrate 1 cc. in­tramuscularly three times a day for 15 days.[4]

Investigations

1. Total leucocyte count 8100/c mm

2. Differential leucocyte count

Polymorphonuclears - 68%

Lymphocytes - 26%

Eosinophils - 2%

Monocytes - 2%

Basophils 1%

3. Total erythrocyte count 4.8 mill/c.mm.

4. Haemoglobin - 80%

5. Urine - Clear no abnormality


  Summary Top


1. A case of Herpes Zoster Ophthalmicus is presented in which keratitis appeared seven days before the appearance of any cutaneous lesion and 24 hours before severe neuralgia.

2. Therapy by Small-pox vaccina­tion as reviewed by Lillie (1947) was given and it appears to have produced beneficial effects on the course of this disease.

3. Post herpetic neuralgia was relieved by nerve block with Xylocain (4 injections in all) and Dihydro-ergo­tamine tartrate 1 cc intramuscularly three times a day for 15 days.

 
  References Top

1.
Abel, B. N.; and Nadbath R. P.; (1952), American J. Ophth. 34, 1035.  Back to cited text no. 1
    
2.
Edgerton, A. E. (1946), Brit J. Ophthal. 34, 40.  Back to cited text no. 2
    
3.
Lillie, W. I., (1947), New York State J. Med. 43, 851.  Back to cited text no. 3
    
4.
Thumin, M., (1919), American J. Ophthal. 32, 1592.  Back to cited text no. 4
    




 

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