Visual Loss Due to Simultaneous Retinal Arteritis and Periphlebitis Complicating Herpes Zoster Ophthalmicus
Pieper A., Gerke E.
Helios Klinikum Wuppertal, Clinical Centre of the University Witten/Herdecke, Dept. of Ophthalmology
Purpose: Herpes zoster commonly affects the first division of the trigeminal nerve, involvement of the intraocular structures and especially the retina is a rare manifestation.
Method: An immuncompetent 63-year-old man noticed visual deterioration in his right eye 3 days after treatment with acyclovir of herpes zoster in a right ophthalmic distribution. When seen on the next day, he had lost vision to light perception. The right lid had typical skin vesicles and ulcerations, slit lamp examination revealed iritis with fibrin formation on the lens surface. The optic nerve had papilledema, the retina was found with multiple intraretinal hemorrhages. The major retinal veins had marked vascular sheathing. Angiografically the arterial perfusion was seen with massive flow impedance. Further treatment with intravenous acyclovir and dexamethason did not result in visual improvement. 10 weeks later the eye had developed neovascular glaucoma which was treated with panretinal photocoagulation.
Conclusions: Both retinal periphlebitis and arteritis complicating herpes zoster ophthalmicus have been described in the literature, a simultaneous manifestation, however, has not been reported to our knowledge.
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