By Helena M. Tabery
Herpes zoster ophthalmicus (HZO) is a typical illness within the aged and the immunosuppressed, with possibly devastating sequelae. analysis of HZO is medical yet just about all its manifestations are non-specific and sometimes indistinguishable from these because of different reasons regularly and herpes simplex virus specifically. The exception is varicella-zoster virus epithelial keratitis, that's often the single indicator of the real nature of the affliction. This e-book is exclusive in featuring high-magnification photographs, acquired by means of non-contact in vivo photomicrography, that trap the exact gains of varicella-zoster virus epithelial keratitis in HZO. either the morphology and the dynamics of the corneal epithelial lesions are wonderfully documented, together with in sufferers with HZO sine herpete and recurrent illness. 3 infrequent situations of ocular floor involvement in acute HZO are integrated, and the ultimate bankruptcy bargains an illuminating comparability of varicella-zoster virus epithelial keratitis in HZO and the lesions of herpes simplex virus. This publication will function an quintessential reduction within the steered prognosis of HZO.
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Extra resources for Varicella-Zoster Virus Epithelial Keratitis in Herpes Zoster Ophthalmicus: In Vivo Morphology in the Human Cornea
12 Day 8, (after 7 days of acyclovir treatment). In (a) are visible foci of damage, partly as light-reflecting surface plaques (long arrows) and partly as damaged surface cells (short arrow); in places are visible lightreflecting dots (arrowhead). (b) shows yellow (adherent) staining with fluorescein sodium of surface plaques (long arrows) and diseased cells (short arrow), and epithelial cysts (black arrows). Also this photograph shows lightreflecting dots (white arrowhead). (c) With rose bengal, the surface plaques (long arrows) and diseased surface cells (short arrow) stain red.
The cornea showed no sequelae of the infection; the only finding was epithelial basement membrane dystrophy. 41 Chapter 3 Recurrent VZV Epithelial Keratitis in HZO; HZO sine Herpete In some patients with HZO, VZV epithelial keratitis recurs. In the present patients, recurrent lesions were indistinguishable from those observed during the HZO episode; both their morphology and their dynamics appeared identical. Such recurrences are less well known but might be more common than suspected. I have seen several patients in whom VZV epithelial keratitis developed between appointments without causing any symptoms that would prompt the patient to attend the Clinic.
In (d) are additionally visible swollen/rounded cells (arrowhead). ) Day 9 area of observation In frame: the area shown below in (a). The black arrowheads are placed in the same location in all photographs. 21 (a) shows red staining of damaged cells (black arrowheads), surface plaques (long white arrows), and penetration of green stained tear fluid into the epithelium (short white arrow; composed photograph). In the pair of photographs (b and c) are visible swollen/rounded cells (white arrowheads) present in areas staining green in (a) and larger rounded structures (black arrow), probably cysts.