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Orbital Inflammatory Syndromes
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Jaspreet Sukhija, Savleen Kaur
Herpes zoster ophthalmicus can be triggered by reactivation of varicella zoster virus that is dormant in the trigeminal nerve ganglia. Reactivation of varicella zoster virus can be triggered by aging, an immunocompromised host, trauma, surgery, iatrogenic immunosuppression, tuberculosis, syphilis, and radiation therapy. Majority of patients with herpes zoster ophthalmicus have ocular complications, including blepharitis, keratoconjunctivitis, iritis, scleritis, and acute retinal necrosis. Ophthalmoplegia was found in 3.5–10.1% of two large herpes zoster ophthalmicus series. Among the cases with extraocular nerve palsies, oculomotor nerve palsy is the most frequent and abducens nerve palsy is the second most frequent.22,23
Skin, soft tissue and bone infections
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Look for evidence of complications – for example look for evidence of sepsis in children with chickenpox, as they may have secondary bacterial infection. If shingles is over the ophthalmic area (herpes zoster ophthalmicus), an eye examination with ophthalmology review needs to be carried out, as keratitis can occur. Herpes zoster oticus (Ramsay Hunt syndrome) includes the triad of ipsilateral facial paralysis, ear pain and vesicles in the auditory canal or on an auricle, reflecting reactivation in the geniculate nucleus. Other complications include pneumonitis, aseptic meningitis, encephalitis, peripheral motor neuropathy, myelitis and Guillain–Barré syndrome.
Varicella Zoster
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
The most common manifestation of varicella zoster reactivation is herpes zoster. Other complications are chronic pain (post-herpetic neuralgia), cranial nerve palsies, zoster paresis, meningoencephalitis, cerebellitis, myelopathy, herpes zoster ophthalmicus (reactivation in the trigeminal nerve) and vasculopathy mimicking giant cell arteritis. These complications may develop without a rash. Herpes zoster ophthalmicus can be accompanied by keratitis, which leads to blindness.
Isolated Sudden-Onset Trochlear Nerve Palsy Associated with Mild Novel Coronavirus Disease (COVID-19) Infection
Published in Journal of Binocular Vision and Ocular Motility, 2023
Mehmet Serhat Mangan, Zeynep Acar
Trochlear nerve palsy is the most common isolated palsy of the extraocular muscles.1 It may not always be possible to differentiate between the congenital and acquired types and an overlap between these two types at presentation can be encountered.1,2 Acquired trochlear nerve palsy is frequently caused by closed head trauma, but uncommonly caused by infarct or tumor compression.1,2 It has rarely been associated with viral infections such as those caused by herpes zoster ophthalmicus,3 herpes simplex-1,4 influenza B,5 human immunodeficiency virus-1,6 human herpesvirus-6,7 and varicella zoster virus.8 We present an otherwise healthy case with isolated trochlear nerve palsy in the setting of a SARS-CoV-2 (COVID-19) infection.
In Vivo Confocal Microscopic Evaluation of the Limbus and Cornea in Vogt Koyanagi Haradas Syndrome
Published in Ocular Immunology and Inflammation, 2022
Radhika Thundikandy, Gowri Priya Chidambaranathan, Naveen Radhakrishnan, Rathinam S. R
IVCM has been used to study the architecture of the cornea in health and disease and its role in the clinical setting has expanded over the last three decades. IVCM has helped quantify epithelial cell density, keratocyte and endothelial cell density, and sub basal nerve plexus. Some of the clinical conditions studied included dry eye syndromes, corneal ectactic conditions like keratoconus and infectious keratitis.11 Changes in the superficial epithelium were seen in Herpes Zoster Ophthalmicus (HZO). In one study on HZO, IVCM demonstrated increase in cell size and decreased cell density which correlated with changes in the corneal innervation.12 Decrease in basal epithelial cell density, endothelial cell damage, and polymegathism have been identified by IVCM in diabetic patients with increasing duration of diabetes.12 Likewise IVCM has shown decrease in keratocyte count in keratoconus patients the decline being more in severe cases.13
Acute Retinal Necrosis from Reactivation of Varicella Zoster Virus following BNT162b2 mRNA COVID-19 Vaccination
Published in Ocular Immunology and Inflammation, 2022
Franklin Zheng, Alex Willis, Nancy Kunjukunju
Two case reports have implicated the administration of vaccines as a potential culprit for the reactivation of zoster.1,2 The clinical appearance of herpes zoster ophthalmicus (HZO) has been noted within several weeks of patients receiving a zoster vaccination.3 As the current SARS-CoV2 (COVID-19) pandemic necessitated the expedition of vaccine development and mass distribution, we are now learning about the potential adverse effects of these newly adopted mRNA vaccines as more individuals are vaccinated. We have encountered limited literature that describe isolated incidents of herpes zoster in patients with pre-existing autoimmune rheumatic disease who received either a first or second dose of COVID-19 vaccine and developed zoster disease within days to weeks of vaccine administration.4 Similar dermatologic findings of herpes zoster were also noted in another individual who received a COVID-19 vaccination several days before symptom onset.5 However, to the best of our knowledge, we have not encountered any reports implicating the association of receiving a COVID-19 vaccine and clinical diagnosis of acute retinal necrosis in the setting of biopsy positive VZV. Institutional review board (IRB) approval was obtained to discuss a case that highlights this association.