Herpes Zoster Ophthalmicus, Persistent Hyphema and Orbital Apex Syndrome; a Blinding Combination

Authors

  • Abirami Shavani Sanmugam Department of Ophthalmology, School of Medical Sciences, Health Campus Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
  • Adil Hussein Department of Ophthalmology, School of Medical Sciences, Health Campus Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
  • Wan Hazabbah Wan Hitam Department of Ophthalmology, School of Medical Sciences, Health Campus Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

Keywords:

Herpes Zoster Ophthalmicus, Hyphema, Orbital Apex Syndrome

Abstract

To report a rare case of an elderly gentleman who presented with herpes zoster ophthalmicus, complicated with persistent hyphema and orbital apex syndrome. A 75-year-old Malay gentleman presented with left herpes zoster ophthalmicus that was complicated with complete ophthalmoplegia and ptosis. He developed total hyphema in the affected eye with a secondary elevated intraocular pressure after a week. He was treated with oral acyclovir and topical corticosteroids. However, the total hyphema persisted that required an anterior chamber washout surgery. Herpes Zoster Ophthalmicus complicated with persistent hyphema and orbital apex syndrome is rare and very challenging to manage. Radiological imaging is important to exclude other causes of OAS. It is recommended to treat HZO with systemic acyclovir for a longer duration in view of ocular and neurological involvement.

Author Biography

  • Abirami Shavani Sanmugam, Department of Ophthalmology, School of Medical Sciences, Health Campus Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
    Department of Ophthalmology, MMed Trainee

References

Yawn B, Gilden D. The global epidemiology of herpes zoster. Neurology 2013; [81: 928–930].

Johnson RW, Alvarez-Pasquin M-J, Bijl M, Franco E, Gaillat J, et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. Therapeutic Advances in Vaccines. 2015; [3(4):109-120].

Othman K, Evelyn-Tai LM, Raja-Azmi MN, Julieana M, Liza-Sharmini AT, et al. Concurrent hyphema and orbital apex syndrome following herpes zoster ophthalmicus in a middle aged lady. International Journal of Surgery Case Reports. 2017; [30:197-200].

Thean JH, Hall AJ, Stawell RJ. Uveitis in Herpes zoster ophthalmicus.Clin Experiment Ophthalmol. 2001; [29:406-410].

Arda H, Mirza E, Gumus K, Oner A, Karakucuk S, et al. Orbital apex syndrome in herpes zoster ophthalmicus. Case Rep. Ophthalmol. Med. 2012

Shirato S, Oshitari T, Hanawa K, Adachi-Usami E.Magnetic resonance imaging in case of cortical apex syndrome caused by varicella zoster virus. Open Ophthalmol. J. 2008; [2(1):109–111].

Chun-Yuan Lee, Hung-Chin Tsai, Susan Shin-Jung Lee, Yao-Shen Chen. Orbital apex syndrome: an unusual complication of herpes zoster ophthalmicus.BMC Infect Dis. 2015; [15: 33].

Walton W, Von Hagen S, Grigorian R, Zarbin M.Management of Traumatic Hyphema. SurvOphthalmol. 2002; [Jul-Aug;47(4):297-334].

Okunuki Y, Junichi Sakai, Takeshi Kezuka,Goto H. A case of herpes zoster uveitis with severe hyphema. BMC Ophthalmol. 2014; [14(1):74].

Akpek E K, J D Gottsch. Herpes zoster sineherpete presenting with hyphema. Ocul. Immunol. Inflamm. 2000; [8(2):115–118].

Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, et al. Recommendations for the management of herpes zoster. Clin Infect Dis 2007; [(Suppl 1):S1–26].

Lee C-Y, Tsai H-C, Lee SS-J, Chen Y-S. Orbital apex syndrome: an unusual complication of herpes zoster ophthalmicus. BMC Infectious Diseases. 2015; [15:33].

Kurimoto T, Tonari M, Ishizaki N, Monta M, Hirata S, et al. Orbital apex syndrome associated with herpes zoster ophthalmicus. Clinical Ophthalmology (Auckland, NZ). 2011; [5:1603-1608].

Wood M-J, Johnson R-W, McKendrick M-W, Taylor J, Mandal B-K, et al.A Randomized Trial of Acyclovir for 7 Days or 21 Days with and without Prednisolone for Treatment of Acute Herpes Zoster.New England Journal of Medicine, 1994;[330(13),896-900].

Whitley RJ, Weiss H, Gnann Jr JW, Tyring S, Mertz GJ, et al. Acyclovir with and without Prednisone for the Treatment of Herpes Zoster: A Randomized, Placebo-Controlled Trial. Ann Intern Med. 1996; [125:376-383].

Downloads

Published

2018-02-09

Issue

Section

Journal of Biomedical and Clinical Sciences