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Orbital Inflammatory Syndromes
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Jaspreet Sukhija, Savleen Kaur
Orbital involvement in ophthalmic zoster is extremely rare but reported. It can occur due to extensive vasculitis, hemorrhage, perineuritis, and inflammatory cell infiltrate affecting all orbital contents including the EOMs and the optic nerve.23 Histopathological studies have demonstrated significant perivascular and perineural inflammation of the ocular tissues, including the optic nerve, cavernous sinus, superior orbital fissure, and retina.
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
For VZV, if <72 hours after onset, antivirals can be used for uncomplicated infections in an immunocompetent host. If >72 hours after onset and new lesions are appearing, antivirals can be given; however, the benefit is unclear. Aciclovir (e.g. 800 mg five times per day for seven days) or valaciclovir (1 g three times a day for seven days). For uncomplicated disease, there is no definite role for adjuvant agents. For complicated zoster infections, refer for a specialist opinion. For ophthalmic zoster, oral or IV antivirals are indicated. For Ramsay Hunt syndrome, consider addition of 1 mg/kg prednisolone for five days.
Varicella-zoster virus
Published in Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward, Case Studies in Infectious Disease, 2010
Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward
The clinical features of shingles are protean, and depend to a large extent on the location of the nerve cell body in which reactivation arises. The shingles rash is acutely painful, and occurs in a dermatomal distribution (see above, and Figure 5). The commonest and most distressing complication is post-herpetic neuralgia (PHN), defined as pain persisting for at least 3 months (although the precise time period may vary between different studies) in the area of a zoster rash after the rash itself has disappeared. The pathogenesis is poorly understood, but it can persist for months or even years, and can have a significantly detrimental effect on the patient’s quality of life. The risk of PHN increases with increasing age of the patient, and is also related to the intensity of the shingles rash (i.e. the number of lesions). Other complications depend on the anatomic location of the rash. Ophthalmic zoster (occurring in the ophthalmic branch of the trigeminal nerve) is particularly serious, as virus may gain access to the cornea, giving rise to an ulcerating zoster keratitis. While mostly thought of as a disease of sensory nerves, motor nerve damage can also arise in zoster, giving rise to lower motor neuron paralysis, for example zoster of the facial nerve (seventh cranial nerve) may give rise to a Bell’s palsy (facial nerve paralysis).
Pathophysiological Considerations in Periorbital Necrotizing Fasciitis: A Case Report
Published in Ocular Immunology and Inflammation, 2023
Yalda Hadizamani, Stefano Anastasi, Anouk Schori, Rudolf Lucas, Justus G. Garweg, Jürg Hamacher
As our case indicates, the differential diagnosis of NF with its rapid periorbital spread is of considerable importance because regular surgical debridement on top of an antibiotic treatment strategy are crucial to ultimately achieve a satisfying outcome. Even after a supportive early control of infection, tissue response to the severe destructive process may require secondary interventions to correct functional anatomic changes during the healing process. From the clinical perspective, the diagnosis of PNF is a challenge, since there are several medical conditions with similar early presentations. As such, ophthalmic zoster must be excluded in the early stages. As the infection progresses, other less common differential diagnoses, including vasculitis of Wegener’s granulomatosis type, erysipelas, Quincke’s edema to preseptal cellulitis, and other inflammatory disorders affecting the lids and orbit have to be considered. Generally, acute fulminant skin infection and pyoderma gangraenosum, as well as other infectious etiologies, including orbital cellulitis, staphylogenic Lyell syndrome, endogenous endophthalmitis, cavernous sinus thrombosis, and rhino-orbital mucormycosis, have to be excluded.2,25,26 Beyond the most important differences between NF of the periorbital region and other parts of the body is the frequently bilateral occurrence in the periorbital region.2,3,5,9 Despite rigid anatomical barriers, pathogens frequently seem to spread across the nasal bridge to the contralateral eyelids, which may best explain the frequent bilateral occurrence of PNF.9
The Neurotropic Varicella Zoster Virus: a Case of Isolated Abducens Nerve Palsy without Skin Rash in a Young Healthy Woman
Published in Strabismus, 2021
Maria Elisa Vares Luís, Carlos Diogo Hipólito-Fernandes, José Lopes Moniz, Joana Tavares Ferreira
As mentioned previously, VZV can manifest as multiple cranial nerve palsies in which the trigeminal (V) and facial (VII) nerves are the most frequently involved.10 Extraocular muscle palsies are not commonly described associated with VZV, but reports demonstrate they can occur in 5–31% of patients with ophthalmic zoster.11–13 The oculomotor cranial nerve (III) is the more frequently affected, followed by the abducens nerve (VI), and then the trochlear nerve (IV).11–13 All three nerves may be involved together as a total ophthalmoplegia.14 The external ocular motor palsies appear, in the majority of the cases, 2–4 weeks following skin involvement, but can occur simultaneously.12,13 Reports show these palsies can appear bilateral and on the side opposite to the skin lesions.11 Usually it is a transient condition that resolve partially or completely after 6–12 weeks.12,13
Safety of topical interventions for the treatment of actinic keratosis
Published in Expert Opinion on Drug Safety, 2021
Elias A. T. Koch, Anja Wessely, Theresa Steeb, Carola Berking, Markus V. Heppt
In contrast to Europe, IM is still approved in the US as a treatment for AK. In the FDA’s AE reporting system (FEARS), 66 cases with cSCC were recorded due to or after topical AK treatment. Notably, 51 of those were related to IM while other agents represented the minority (n = 8 for 5-FU, n = 5 for IMQ, n = 1 for MAL-PDT, n = 1 for ALA-PDT) [101]. Furthermore, the FDA reported severe allergic reactions, herpes zoster, and ophthalmic zoster associated with the use of IM in this registry [102].