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Se desconoce qué desencadena el herpes zoster, pero la incidencia aumenta conforme a la edad. AP: HTA, adenocarcinoma prostatico (3b-3c) con revisiones trimestrales, insuficiencia venosa cronica, glaucoma. EF: Lesiones ampollosas en distintas fases evolutivas que afectan a una metamera sin traspasar la linea media. Comentario: La sospecha inicial de herpes zoster asi como el inicio precoz del tratamiento antiviral es fundamental en la buena evolucion clinica de estos pacientes.
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A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic.
Herpes zoster ophthalmicus in patients at risk for the acquired immune deficiency syndrome (AIDS). Natural history of herpes zoster ophthalmicus: predictors of postherpetic neuralgia and ocular involvement. Varicella zoster virus retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults.
Comparison of the efficacy and safety of valaciclovir and acyclovir for the treatment of herpes zoster ophthalmicus. Las consultas por manifestaciones agudas del herpes zoster (HZ) son muy frecuentes en los consultorios de atención primaria, sin embargo muchos profesionales no realizan un tratamiento adecuado. It is a member of the same family (Herpesviridae) as herpes simplex virus, Epstein-Barr virus, and cytomegalovirus.
Because the nasociliary branch innervates the globe, the most serious ocular involvement develops if this branch is affected. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Mais a frente aparece uma dor muito intensa que produz sensacao de queimacao e surgem entao as vesiculas que se distribuem ao largo da zona afetada, seguindo, na maioria dos casos, o curso dos nervos intercostais.
Most patients with herpes zoster ophthalmicus present with a periorbital vesicular rash distributed according to the affected dermatome. Reactivation of the latent virus in neurosensory ganglia produces the characteristic manifestations of herpes zoster, commonly known as shingles.
Classically, involvement of the tip of the nose (Hutchinson's sign) has been thought to be a clinical predictor of ocular involvement. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
Ao fim de 5 dias as vesiculas comecam a secar e formam cascas que ao cairem nao deixam vestigio, a nao ser que fiquem ulceradas.A herpes zoster pode generalizar-se e produzir uma grande disseminacao.
Con frecuencia a la gente a la cual le da HZO ha tenido varicela o ha sido expuesto al virus de la varicela en el pasado. Elsevier 3904 páginasIm, BJ Kim, YJ Seo, JK Park, JH Lee Complete ophthalmoplegia after herpes zoster.
A minority of patients may also develop conjunctivitis, keratitis, uveitis, and ocular cranial-nerve palsies.


Normal aging, poor nutrition, and immunocompromised status correlate with outbreaks of herpes zoster, and certain factors such as physical or emotional stress and fatigue may precipitate an episode.Herpes zoster ophthalmicus occurs when reactivation of the latent virus in the trigeminal ganglia involves the ophthalmic division of the nerve. Treatment includes topical capsaicin cream, over-the-counter analgesics, tricyclic antidepressants, and anticonvulsants.18Cranial nerve palsies involving the third (most common), fourth, and sixth nerves may occur rarely (Figure 5).
Se as lesoes persistirem por mais de duas semanas, pode-se suspeitar de algum processo maligno ou de uma falha imunologica.
Si usted tiene HZO usted le puede transmitir el virus que causa la varicela a otras personas.
El medicamento para el dolor tal como la aspirina y el acetaminofeno (Tylenol) pueden ayudarle. Clinical and Experimental Dermatology,(2007) Volume 32, Issue 2, Page 162-164 HJ Thean, AJH Hall, RJ Stawell. Permanent sequelae of ophthalmic zoster infection may include chronic ocular inflammation, loss of vision, and debilitating pain. Em certas ocasioes, principalmente nos velhos, uma vez curada a doenca permanecem durante meses dores nervosas sobre a zona.Nao existe um tratamento especifico.
Por lo tanto, usted debe evitar entrar en contacto con personas que no han tenido varicela, especialmente mujeres embarazadas, y con pacientes muy enfermos tales como pacientes con cáncer o SIDA. Aunque muchos de los pacientes que no tienen trastornos de la inmunidad puedan recuperarse espontáneamente y en forma completa en solo semanas, algunos pacientes sufren complicaciones graves como las neuralgias y las alteraciones visuales.
Antiviral medications such as acyclovir, valacyclovir, and famciclovir remain the mainstay of therapy and are most effective in preventing ocular involvement when begun within 72 hours after the onset of the rash.
Direct ocular involvement is not specifically correlated with age, gender, or severity of disease. Optic neuritis has been noted in about one in 400 cases and may precede retinal disease or follow acute herpes zoster ophthalmicus infection (Figure 6).17,19,20The rightsholder did not grant rights to reproduce this item in electronic media.
Oral acyclovir may be beneficial as an adjunct to topical antivirals and topical steroids in severe cases of zoster keratouveitis. E conveniente proteger as vesiculas contra as infeccoes secundarias e aplicar sobre elas compressas umidas com o objetivo de aliviar a dor.
Timely diagnosis and management of herpes zoster ophthalmicus, with referral to an ophthalmologist when ophthalmic involvement is present, are critical in limiting visual morbidity. Patients may develop blepharitis and present with ptosis secondary to edema and inflammation.
A vast majority of patients will have vesicular lesions on the eyelids that resolve with minimal scarring.Conjunctivitis is one of the most common complications of herpes zoster ophthalmicus.
The conjunctiva appears injected and edematous, often with petechial hemorrhages.9 The findings usually resolve within one week. Visual prognosis in immunocompetent patients with herpes zoster ophthalmicus.Acta Ophthalmol. The clinical features of corneal disease include direct viral infection, antigen-antibody reactions, delayed cell-mediated hypersensitivity reactions, and neurotrophic damage.7 Patients with corneal disease present with varying degrees of decreased vision, pain, and light sensitivity. Corneal complications occur in approximately 65 percent of cases of herpes zoster ophthalmicus.7Epithelial Keratitis. The earliest corneal finding is punctate epithelial keratitis.10 On slit lamp examination, this appears as multiple, focal, swollen lesions that stain with rose bengal or fluorescein dye. These lesions probably contain live virus and may either resolve or progress to dendrite formation.


Punctate epithelial keratitis may present as early as one or two days after the initial skin rash, while dendrites often present at four to six days but can appear many weeks later.11Herpes zoster virus dendrites appear as elevated plaques and consist of swollen epithelial cells. Dendrites also stain with rose bengal and fluorescein dye ( Figure 2, part b) and can be viewed by Wood's lamp or slit lamp examination.
The earliest finding of corneal stromal involvement presents during the second week of disease, occurring in 25 to 30 percent of patients with herpes zoster ophthalmicus.13 The condition, known as anterior stromal keratitis or nummular keratitis, is characterized by multiple fine granular infiltrates in the anterior corneal stroma below the epithelial layer (Figure 3). Most of the infiltrates lie directly beneath pre-existing dendrites or areas of punctate epithelial keratitis. El aciclovir es el antiviral con mayor evidencia científica sobre su efectividad para disminuir el porcentaje de complicaciones oculares y para reducir el dolor agudo. This later stage of stromal keratitis is relatively uncommon and typically develops three to four months after the initial acute episode, but development can range from one month to many years later.7 It is usually central and preceded by anterior stromal keratitis.
The keratitis may present as a lesion consisting of a localized area of inflammation affecting all levels of the stroma, or as peripheral infiltrates that may have a surrounding immune ring. Corneal edema may be a prominent feature at this stage, usually with associated anterior chamber inflammation. Aunque el paciente no haya consultado al oftalmólogo, debe iniciar el tratamiento antiviral oral. A chronic relapsing course is not unusual, especially without timely and adequate treatment. Corneal neovascularization and lipid infiltrates may occur in patients with uncontrolled chronic disease. The pathogenesis of stromal disease probably involves a delayed cell-mediated hypersensitivity reaction.Neurotrophic Keratopathy. Neurotrophic keratitis is the end result of decreased corneal sensation from herpes zoster virus-mediated destruction, including susceptibility to mechanical trauma, decreased lacrimation, and delayed epithelial healing.7 Corneal thinning is a serious complication that may lead to corneal perforation. Por este motivo, este antecedente personal debe figurar en la historia clínica del paciente. Using preservative-free lubricating drops and ointment can prevent the development of epithelial defects.UVEITISAnterior uveitis, which is diagnosed by slit lamp examination, refers to inflammation of the iris and ciliary body and occurs frequently with herpes zoster ophthalmicus. The inflammation is generally mild and transient, but it frequently causes a mild elevation in intraocular pressure. As with stromal keratitis, the course of disease may be prolonged, especially without timely, adequate treatment. Chronic inflammation can lead to endothelial cell injury, resulting in corneal edema.EPISCLERITIS AND SCLERITISFindings of episcleritis include localized or diffuse redness, as well as pain and swelling of the conjunctiva and episclera. Both conditions may be accompanied by localized stromal keratitis.ACUTE RETINAL NECROSIS AND PROGRESSIVE OUTER RETINAL NECROSIS SYNDROMESHerpes zoster virus is considered the offending agent in most cases of acute retinal necrosis and progressive outer retinal necrosis syndromes. Acute retinal necrosis is characterized by peripheral patches of retinal necrosis that rapidly coalesce (Figure 4), occlusive vasculitis, and vitreous inflammation. Conversely, immunocompromised patients with progressive outer retinal necrosis are unable to mount a vitreous inflammatory response, leading to rapid involvement of the macula.



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