Journal List > J Korean Ophthalmol Soc > v.56(5) > 1010285

Son, Kim, and Lee: A Case of Multiple Complications in Herpes Zoster Ophthalmicus

초록

Purpose:

We report a case of stromal keratitis, corneal infiltration, anterior uveitis, central retinal artery occlusion and optic neuropathy in a patient with herpes zoster ophthalmicus.

Case summary:

A 73-year-old man who was hospitalized for pain and vesicles on his left face was referred to our clinic with sudden onset visual disturbance in his left eye. His best corrected visual acuity in the right eye was 0.8 and light-perception in his left eye. Relative afferent pupillary defect was found in his left eye. Slit-lamp examination showed anterior uveitis secondary to herpes zoster ophthalmicus presented with stromal keratitis. Fundus examination showed retinal hemorrhage, vitreous opacity, cherry-red spot in the fovea and optic disc swelling. Delayed arterial filling and arteriovenous transit time were observed on fluorescence angiography. He was treated with topical antiviral and steroid eye drops for stromal keratitis and anterior uveitis. He was also treated systemically with an intravenous antiviral agent and oral steroid, but visual acuity did not improve.

Conclusions:

Stromal keratitis, corneal opacity, anterior uveitis, central retinal artery occlusion and optic neuropathy can be complications of herpes zoster ophthalmicus.

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Figure 1.
Photograph of patient showing vesicle and crust in left ophthalmic branch of trigeminal nerve dermatome with lesions on tip of the nose (Hutchinson’s sign).
jkos-56-789f1.tif
Figure 2.
At the first visit. (A) The left eye showed corneal edema and stromal keratitis. (B) Slit lamp photograph of the left eye; anterior chamber reaction and keratic precipitates on the corneal endothelium.
jkos-56-789f2.tif
Figure 3.
(A) Fundus photograph of the left eye showing retinal hemorrhages, disc edema and macular opacification with a cherry-red spot at the initial visit. (B) Six months later, fundus photograph of the left eye shows narrowing of the retinal arteries and optic disc pallor.
jkos-56-789f3.tif
Figure 4.
Fluorescein angiography of the left eye at the initial visit. (A) At 29 seconds after injection, filling of arterioles are still incomplete. (B) At 55 seconds after injection, filling of retinal vein is still incomplete. The left eye shows a delayed arm-to-retinal circulation and arteriovenous transit time.
jkos-56-789f4.tif
Figure 5.
Magnetic resonance imaging shows slightly enhanced left optic nerve after contrast injection on T2-weighted image (white arrowhead).
jkos-56-789f5.tif
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