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LETTER TO THE EDITOR
Year : 2009  |  Volume : 57  |  Issue : 2  |  Page : 163-164

Herpes zoster ophthalmicus or Herpes zoster maxillaris?


Department of Ophthalmology, S. S. Medical College and Gandhi Memorial Hospital Rewa, M.P - 486 001, India

Date of Web Publication17-Feb-2009

Correspondence Address:
Shivcharan Lal Chandravanshi
Department of Ophthalmology, Gandhi Memorial Hospital Rewa, MP - 486 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.45517

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How to cite this article:
Chandravanshi SL, Rathore M K. Herpes zoster ophthalmicus or Herpes zoster maxillaris?. Indian J Ophthalmol 2009;57:163-4

How to cite this URL:
Chandravanshi SL, Rathore M K. Herpes zoster ophthalmicus or Herpes zoster maxillaris?. Indian J Ophthalmol [serial online] 2009 [cited 2020 Feb 17];57:163-4. Available from: http://www.ijo.in/text.asp?2009/57/2/163/45517

Dear Editor,

We read with interest the article by Biswas et al . [1] The authors deserve to be congratulated for highlighting the anterior segment manifestations of human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS). We have certain observations to make.

  1. The authors have given a good external photograph of AIDS patient with facial skin lesions, [1] which clearly looks like a case of herpes zoster maxillaris rather than herpes zoster ophthalmicus. Involvement of forehead skin is a classical feature of herpes zoster ophthalmicus. In the picture shown [Figure 1] the forehead skin was totally spared and maxillary division of trigeminal nerve supplying the facial dermatomes was involved.
  2. Dacryocystitis, basal cell carcinoma, chalazion, bacterial folliculitis, madarosis, stye, scleritis, episcleritis, complicated cataract, were also well documented rare anterior segment and adnexal manifestations of HIV and AIDS. [2],[3],[4]
  3. The authors fail to highlight orbital manifestations like orbital lymphoma, orbital eosinophilic granuloma, orbital cellulitis [Figure 1], orbital abscess, subperiosteal abscess formation in HIV and AIDS patients. Opportunistic infections caused by bacteria, virus, fungi and protozoan organism have been associated with AIDS that may involve the orbit and sinuses. Orbital involvement usually occurs due to spread of infections from paranasal sinuses. Invasive or fulminant aspergillosis of the orbit carries a poor prognosis, particularly when the immunosuppressed state cannot be reversed. Pneumocystic carinii can affect the orbit in patients of HIV. Patients can present with proptosis, blurred vision, pain on eye movement, and papillodema. Orbital pneumocystis carnii responds very well with trimethoprim-sulfamethoxazole. Orbital abscess responds to surgical drainage and intravenous antibiotics. [2],[4]
  4. The development of multiple warts (verruca vulgaris) in the periocular region can be seen in patients with HIV infection. A DNA containing papilloma virus causes the lesions of verruca vulgaris. They appear as circumscribed, elevated growths with a hyperkeratotic, filiform surface. Treatment options include surgical excision, electrocautry, cryotherapy, and application of trichloroacetic acid. [3]
  5. Non-Hodkins lymphoma (NHL) is the most frequent orbital manifestation of AIDS, yet it occurs relatively infrequently based on isolated case reports in the ophthalmic literature.These tumors behave more aggressively with multiple atypical features in AIDS patients compared with immunocompetent persons. In the general population, orbital lymphomas classically present as insidious, painless, slowly progressive lesions in the superior orbit with mild axial or non-axial displacement of the globe. In contrast AIDS related orbital lymphomas tend to develop more rapidly with painful eyelid swellings, proptosis, diplopia, or diminution of vision. NHL associated with HIV infections is generally monoclonal B cell proliferation that exhibits an aggressive histological pattern. [2],[4]


 
  References Top

1.
Biswas J, Sudharshan S. Anterior segment manifestations of human immunodeficiency virus/Acquired immune deficiency syndrome. Indian J Ophthalmol 2008;56:363-75.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Mansour AM. Orbital findings in Acquired immunodeficiency syndrome. Am J Ophthalmol 1990;110:706-7.  Back to cited text no. 2
[PUBMED]    
3.
Kestlyn P. Ocular problems in AIDS. Int Ophthalmol 1990;14:165-72.  Back to cited text no. 3
    
4.
Mansour AM. Adnexal findings in AIDS. Ophthal Plast Reconstr Surg 1993;9:273-9.  Back to cited text no. 4
[PUBMED]    


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  [Figure 1]


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1 Authors′ reply
Biswas, J., Sudharshan, S.
Indian Journal of Ophthalmology. 2009; 57(2): 164
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