Upload
mariam-kashif
View
1.568
Download
0
Embed Size (px)
Citation preview
DEPARTMENT OF OPHTHALMOLOGYDEPARTMENT OF OPHTHALMOLOGY
SINDH GOVT. QATAR HOSPITALSINDH GOVT. QATAR HOSPITAL
DR MARIAM KASHIFDR MARIAM KASHIFPOST GRADUATE STUDENT(MCPS)POST GRADUATE STUDENT(MCPS)
DR JAMEEL AHMED BURNEYDR JAMEEL AHMED BURNEYSUPERVISOR/HEAD OF DEPARTMENTSUPERVISOR/HEAD OF DEPARTMENT
CaseCase
A 35 year old man presented with A 35 year old man presented with FeverFever - 4days- 4daysBurning sensation on forehead Burning sensation on forehead
and around left eyeand around left eye - 2 days- 2 daysVesicular eruptionsVesicular eruptions - 1 day- 1 dayDischarge (LE)Discharge (LE) - 1 day- 1 dayDV (LE)DV (LE) - 1 day- 1 day
HistoryHistory
Low grade fever 4 days back associated Low grade fever 4 days back associated with headache, tiredness and malaise.with headache, tiredness and malaise.
Pain and Burning sensation on left side of Pain and Burning sensation on left side of forehead and around left eye.forehead and around left eye.
1 day back eruption of groups of vesicles 1 day back eruption of groups of vesicles on left side of forehead, left upper eyelid on left side of forehead, left upper eyelid and nose associated with itching and pain.and nose associated with itching and pain.
Redness and mucopurulent discharge Redness and mucopurulent discharge from left eye along with decreased vision.from left eye along with decreased vision.
Past HistoryPast History
No long term illness, decreased appetite No long term illness, decreased appetite or weight loss.or weight loss.
No drug history or known drug allergies.No drug history or known drug allergies. H/O chicken pox at the age of 10yrs.H/O chicken pox at the age of 10yrs.
Family and Social HistoryFamily and Social History
Unmarried, lives with parents and two Unmarried, lives with parents and two siblings; all healthy.siblings; all healthy.
No addictions.No addictions. Works in garment factory.Works in garment factory. Belongs to middle class family.Belongs to middle class family.
Medical ExamMedical Exam
Well oriented young man, in pain and Well oriented young man, in pain and concerned about his condition.concerned about his condition.
Vitals: Blood pressure 120/70mmhg, pulse Vitals: Blood pressure 120/70mmhg, pulse 80/min,temp 98 degree.80/min,temp 98 degree.
CV: regular without murmur or gallop.CV: regular without murmur or gallop. Chest: clear.Chest: clear. Abdomen: no significant finding.Abdomen: no significant finding.
Ocular ExamOcular Exam
Visual Acuity 6/6 RE 6/12 LEVisual Acuity 6/6 RE 6/12 LE External Inspection :erythamatous skin, groups External Inspection :erythamatous skin, groups
of flesh colored vesicles on left side of forehead, of flesh colored vesicles on left side of forehead, left upper eyelid, along lid margin, side and tip of left upper eyelid, along lid margin, side and tip of the nose. (Hutchinson's Sign)the nose. (Hutchinson's Sign)
Bilateral Ocular Motility normalBilateral Ocular Motility normal Pupillary reactions normalPupillary reactions normal
Slit Lamp ExaminationSlit Lamp ExaminationRIGHT EYERIGHT EYE LEFT EYELEFT EYE
ConjunctivaConjunctiva NormalNormal HyperemiaHyperemia
CorneaCornea ClearClear
Sensation Sensation normalnormal
Ulcer Ulcer (Dendritic in (Dendritic in patternpattern
Fluorescine +ve)Fluorescine +ve)
Sensation reducedSensation reduced
Anterior Anterior chamberchamber
NormalNormal NormalNormal
LensLens ClearClear ClearClear
FundusFundus NormalNormal NormalNormal
Differential Diagnosis Differential Diagnosis
OCULAROCULAR SKIN SKINHerpes simplex keratitisHerpes simplex keratitis Drug allergy Drug allergy
Herpes zoster ophthalmicusHerpes zoster ophthalmicus Contact dermatitis Contact dermatitis
Insect biteInsect bite
DiagnosisDiagnosis
HERPES ZOSTER OPHTHALMICUSHERPES ZOSTER OPHTHALMICUS HistoryHistory Vesicles (Hutchinson’s Sign)Vesicles (Hutchinson’s Sign) Dendritic ulcerDendritic ulcer
Varicella zoster virusVaricella zoster virus
Double stranded DNA virusDouble stranded DNA virus AlphaherpesvirinaeAlphaherpesvirinae
OverviewOverview
VARICELLA ZOSTER VIRUSVARICELLA ZOSTER VIRUSChicken poxChicken pox dorsal root ganglia dorsal root ganglia reactivation reactivation shingles shingles
single single dermatomedermatome
Risk FactorsRisk Factors
90% susceptible after primary infection90% susceptible after primary infection Old ageOld age ImmunosupressionImmunosupression MalignancyMalignancy Severe illnessSevere illness
Herpes Zoster OphthalmicusHerpes Zoster Ophthalmicus
Involvement of first Division (Ophthalmic) Involvement of first Division (Ophthalmic) of Trigeminal nerveof Trigeminal nerve
SymptomsSymptoms
Prodromal (fever ,fatigue ,malaise, headache)Prodromal (fever ,fatigue ,malaise, headache) Burning pain (forehead ,eyelid ,nose)Burning pain (forehead ,eyelid ,nose) VesiclesVesicles Red EyeRed Eye Watering/DischargeWatering/Discharge PhotophobiaPhotophobia Decreased visionDecreased vision
Signs (Ex.Ocular)Signs (Ex.Ocular)
Hutchinson’s SignHutchinson’s Sign
( vesicles on forehead, upper eyelid, side & ( vesicles on forehead, upper eyelid, side & tip of nose)tip of nose)
Hutchinson's signHutchinson's sign
Signs (ocular)Signs (ocular) ConjunctivitisConjunctivitis
(Hyperemia, discharge)(Hyperemia, discharge)
Signs (ocular)Signs (ocular) KeratitisKeratitis Dendritic corneal ulcer ( Fine branching pattern)Dendritic corneal ulcer ( Fine branching pattern)
Dendritic ulcerDendritic ulcer
Signs (ocular)Signs (ocular)
StainingStaining
Fluorescein
Rose Bengal
Signs (ocular)Signs (ocular)
Corneal epithelial defects and ulcersCorneal epithelial defects and ulcers
Signs (ocular) Signs (ocular)
Anterior Uveitis (affects a third of patients) Anterior Uveitis (affects a third of patients) Red eyeRed eye Cells, flareCells, flare Posterior synachiaePosterior synachiae Keratic precipetates (KPs)Keratic precipetates (KPs)
Posterior Synachiae
Anterior UveitisAnterior Uveitis
KPs
Signs (ocular)Signs (ocular)
EpiscleritisEpiscleritis ScleritisScleritis Stromal keratitisStromal keratitis Disciform keratitisDisciform keratitis
ComplicationsComplications Post herpetic neuralgiaPost herpetic neuralgia : pain that remains for more than 1 : pain that remains for more than 1
month after rash has healedmonth after rash has healed75% cases (esp. over 70yrs)75% cases (esp. over 70yrs)aggravated by minor stimuli (touch ,heat) aggravated by minor stimuli (touch ,heat)
Cranial nerve palsies Cranial nerve palsies Third (most common)Third (most common)Fourth & sixthFourth & sixth
Optic neuritisOptic neuritis EncephlitisEncephlitis Rare Rare Cranial arteritisCranial arteritis Guillain-Barre syndromeGuillain-Barre syndrome
Ocular complicationsOcular complications
Eyelid scarringEyelid scarring Raised IOP (steroid induced)Raised IOP (steroid induced) Neurotrophic keratitisNeurotrophic keratitis Chronic scleritisChronic scleritis Lipid degeneration (cornea)Lipid degeneration (cornea)
TreatmentTreatmentSystemic :Within 72hrs
Acyclovir 800mg 5 times daily
Famciclovir 500mg TID
Local:Local: Acyclovir skin ointment (rash)Acyclovir skin ointment (rash) Topical AcyclovirTopical Acyclovir Topical antibiotics (Chloramphenicol)Topical antibiotics (Chloramphenicol) Topical steroids (uveitis)Topical steroids (uveitis)
TreatmentTreatment
Treatment of ComplicationsTreatment of Complications
Post herpetic neuralgiaPost herpetic neuralgia Cold compressCold compress Local CAPSAICIN oint (QID) / Local CAPSAICIN oint (QID) /
LIDOCAINE ointLIDOCAINE oint Pain killers Pain killers Oral Tricyclic antidepressantsOral Tricyclic antidepressants
No Post herpetic neuralgiaNo Post herpetic neuralgia
Message Message
A common and treatable viral infection.A common and treatable viral infection. Patient education/Counseling. Patient education/Counseling. Post herpetic neuralgia is extremely Post herpetic neuralgia is extremely
painful condition.painful condition. Can transmit chicken pox.Can transmit chicken pox.