Ashwini K V

Abstract

Introduction: Herpes Zoster Ophthalmicus (HZO) is a viral infection caused by varicella zoster virus. The virus manifests in primary and recurrent forms. HZO involves ophthalmic division of trigeminal nerve affecting one or all other branches (lacrimal, supratrochlear, nasociliary). The diagnosis is simple with clinical examination in majority of cases. The lifetime risk of herpes zoster is estimated to be 10 to 20 percent. The complications are seen in primary and recurrent herpes zoster both in immunocompetent and immunocompromised patients. Aims: To analyses varied clinical manifestation in herpes zoster ophthalmicus. Materials and Methods: We analysed 40 cases of established HZO. The demographic profile, clinical signs and symptoms, and outcomes were observed and analysed. They were screened for diabetes and hypertension as a part of routine checkup. HbA1c (glycosylated Hb) was done in all diabetics. Serological testing for HIV, HbsAg, & VDRL was done in all cases. History of chicken pox in the past was documented if any. Results: All 40 cases had conjunctival and corneal involvement. 11(27.5%) out of 40cases, had complete dermatomal involvement,17(42.5%) had intra ocular involvement. 7 patients had uncontrolled diabetes with HbA1c values between 8 to 10. 13 patients had deep seated retro ocular pain before the onset of skin leision. Conclusion: HZO take a longer course in patients with abnormal HbA1c values. Multiple dermatomal involvement can be observed. Deep seated retro ocular pain along with burning sensation along the distribution of nerve should arouse high index of suspicion of HZO, as a premonitory symptom. The skin lesions appear different with edematous skin in albino patient. Keywords: Herpes virus, Multiple dermatome involvement, Retro ocular pain, Uncontrolled diabetes, Vaccine.

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Abstract

Purpose: To correlate the association of pseudoexfoliation with spheroidal degeneration, and to identify the type and stage of spheroidal degeneration in pseudoexfoliation patients. Material and Methods: Total of 64 patients between the age group of 40 to 70 years, attending Ophthalmology out-patient department were included in this study. After taking informed consent, demographic details and detailed history were taken from these patients. Comprehensive ophthalmic examination, which included visual assessment by Snellens chart and anterior segment evaluation by slit lamp examination was done. Results: A total of 64 patients (41 male and 23 female), in the age group between 40 and 70years, with pseudoexfoliation were included. Out of the 64patientswith pseudoexfoliation who were screened in our outpatient department, 44(68.75%) patients were diagnosed to havespheroidal degeneration. Among these 28(43.75%) patients were having stage 1, 7(10.93%) patients were having stage 2, 5(7.81%) patients had stage 3 and, 4(6.25%) patients had stage 4 spheroidal degeneration. Conclusion: Pseudoexfoliation cases have higher incidence of spheroidal degeneration association as compared to general population. It was also observed that droplet type (stage 1) of spheroidal degeneration was commonly seen in pseudoexfoliation cases, and the pupillary margin was the common site for pseudoexfoliation material deposition in most of the cases. This poses challenges to measure intraocular pressure effectively, as well as increase the chances of complications when intraocular procedures are done even with experienced hands. Keywords: Cataract, Droplet type, Exfoliation material, Pseudoexfoliation, Phacodonesis, Spheroidal degeneration.

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