Diagnoses and Management of Herpes Viruses: Zoster vs. Simplex

39970-SD

Andrew S. Gurwood, OD, FAAO, Dipl.

Marc D. Myers, OD, FAAO

Varicella Zoster Virus (VZV) and Herpes Simplex Virus (HSV) are enveloped, double-stranded deoxyribonucleic acid (DNA) viruses that belong to the Herpesviridae family. Herpes Zoster Ophthalmicus (HZO) is a recurrent infection of the varicella-zoster virus which occurs when it involves the ophthalmic division of the trigeminal nerve. It represents 10%-25% of all cases of Herpes Zoster. HZO can lead to devastating ocular and systemic complications and is often first diagnosed by ophthalmic physicians. HSV-1 is commonly associated with orofacial disease while HSV-2 is associated with genital disease. HSV-1 remains a leading cause of unilateral corneal blindness from infectious disease worldwide. This lecture highlights the proper diagnosis, management and follow-up of HZO and HSV induced ocular diseases.

Course Objectives
1. To clarify the signs and symptoms which aide in the differentiation between HZV

and HSV.

2. To enhance the ability to formulate a differential diagnosis, work-up protocol and

management strategy when presented with Herpes viruses.

3. To enhance the ophthalmic practitioner’s ability to co-manage with other ophthalmic

Professionals and primary care physicians.

Summary/Outline

I.  HZO

  1. Primary infection: Chicken Pox
  2. Pathophysiology
  3. Route of infection
  4. Incubation period
  5. Contagiousness
  6. Symptoms
  7. Reactivation: Herpes Zoster/Shingles
  8. Pathophysiology
  9. Occurrence Sites
  10. Thoracic dermatomes
  11. Lumbosacral dermatomes
  12. Cranial nerves: Trigeminal and Facial nerve
  13. Anatomy of Trigeminal Nerve
  14. Ophthalmic division
  15. Nasociliary Nerve
  16. Maxillary division
  17. Mandibular division
  18. Ocular Manifestations
  19. Anterior Segment
  20. Keratitis – Pseudodendrites
  21. Decreased corneal sensitivity
  22. Scarred Lid Retraction
  23. Conjunctivitis
  24. Episcleritis
  25. Scleritis
  26. Uveitis
  27. Posterior Segment
  28. Retinitis
  29. Choroiditis
  30. Cranial nerve palsy
  31. Glaucoma
  32. Non-Ocular Complications: Postherpetic neuralgia
  33. Risk factors
  34. Treatment
  35. Systemic treatments – medications and timing
  36. Prevention
  37. Vaccination for Varicella – Varivax
  38. Vaccination for Herpes Zoster - Zostavax
  39. Topical ophthalmic treatments
  40. Topical non-ophthalmic treatments
  41. Postherpetic neuralgia management
  42. HIV, HAART and Herpes Zoster

II.  HSV

  1. Differentiate HSV-1 and HSV-2
  2. Primary Infection
  3. Pathophysiology
  4. Route of infection
  5. Incubation period
  6. Contagiousness
  7. Symptoms
  8. Reactivation of HSV-1
  9. Environmental factors: UV light, temperature
  10. Occurrence Sites
  11. Ocular Manifestations:
  12. Conjunctivitis
  13. Punctate Keratitis
  14. Dendritic Keratitis
  15. Geographic ulcer
  16. Disciform Keratitis
  17. Interstitial keratitis
  18. Iridocyclitis
  19. Retinitis
  20. Herpetic Eye Disease Studies
  21. HEDS I
  22. The efficacy of topical corticosteroids in treating stromal keratitis in conjunction with topical trifluridine (SKN).
  23. The efficacy of oral acyclovir in treating stromal keratitis in conjunction with topical corticosteroids and topical trifluridine (SKS).
  24. The efficacy of oral acyclovir in treating iridocyclitis in conjunction with topical corticosteroids and trifluridine (IRT).
  25. HEDS II
  26. The benefit of early treatment with oral acyclovir in preventing stromal keratitis and iridocyclitis in patients with ulcerative keratitis (EKT).
  27. The benefit of oral acyclovir in preventing recurrent HSV ocular infection (APT).
  28. The external factors on the induction of recurrences of HSV ocular diseases (RFS).
  29. Treatment
  30. Topical
  31. Systemic – treatment vs. preventative care