ocular herpes

Symptoms

Patients often experience local pain, itching, burning, dysuria, or other uncomfortable sensations that sometimes begin before a rash or lesion(s) appears on the skin. The skin lesion consists of a reddened patch or small blisters (vesicles) or pustules that ulcerate before healing. These typically take about 10 days to heal. Regional lymph nodes often enlarge and become tender. Systemic symptoms (e.g., fever and malaise) sometimes accompany the initial outbreak or recurrences. However, asymptomatic shedding of the virus is common and may represent the most common way in which the virus is transmitted from person to person.

Potential Complications

Genital herpes may be transmitted to the newborn during childbirth and may cause serious complications, including respiratory illnesses, retinal infection, liver infection, encephalitis, mental retardation, blindness, deafness, seizures, microcephaly, and diabetes insipidus. Cesarean delivery or maternal suppression of the virus with acyclovir are two methods used to prevent newborn infection. Poor hand hygiene may transmit the virus to the eye(s), resulting in herpetic keratoconjunctivitis.

Treatment

Oral acyclovir or its derivatives can treat both the initial outbreak and subsequent recurrences and diminish asymptomatic viral shedding.

CAUTION!

Patient care

The patient should be taught to avoid all skin-to-skin contact when lesions are present and to practice safe sex. Patients should not share towels or other personal care items. Patients with genital herpes often experience anger, self-doubt, fear, or guilt, esp. at the time of initial diagnosis or during recurrences. Counseling and support may help the patient address these issues. Patient education improves understanding of the prevalence of the disease in the general population, the recurring nature of the eruption, safe sexual practices, medication use, and psychosocial and relationship issues.

The incubation period is from 7 to 21 days. The total duration of the disease from onset to complete recovery varies from 10 days to 5 weeks. If all the vesicles appear within 24 hr, the total duration is usually short. In general, the disease lasts longer in adults than in children. It is estimated that about 50% of people who live to age 80 will have an attack of herpes zoster. This infection is more common in persons with a compromised immune system: older adults, those with AIDS or illnesses such as Hodgkin's disease and diabetes, those taking corticosteroids, or those undergoing cancer chemotherapy.

Pain often develops along affected skin and persists for months after resolution of the rash. This discomfort, which may be severe in patients older than 50, is known as postherpetic neuralgia. It may intensify at night or worsen when clothes rub against the skin. Synonym: shinglesillustration; herpes zoster ophthalmicus;

Diagnosis

Diagnosis is usually made based on clinical assessment. If further studies are required, the CDC recommends direct fluorescent antibody testing of specimens collected by rubbing a swab on the base of an open lesion.

Treatment

In healthy adults, acyclovir, famciclovir, and valacyclovir are effective in reducing viral shedding and nerve pain damage if administered within 3 days of onset of the rash. Corticosteroids, gabapentin, pregabalin, nonsteroidal anti-inflammatory drugs, some antidepressants, and narcotics may decrease the pain of postherpetic neuralgia. Itching may be reduced with colloidal oatmeal or other topical treatments. Capsaicin cream (an extract of hot chili peppers) may be applied topically for pain relief, but this should be done only after active lesions have subsided.

Patient care

The prescribed antiviral agent is administered and explained to the patient, along with information about desired and adverse effects. Skin lesions are inspected daily for signs of healing or secondary infection; the patient's response to treatment is evaluated regularly, and he is monitored for associated complications. Prescribed analgesics are given on a schedule to minimize neuralgic pain. Patients experiencing neuralgia following the acute stage of the disease should be referred for ongoing therapy. He is reassured that HSV pain will subside eventually, that the prognosis for complete recovery is good, and that the infection seldom recurs.

prevention

Reactivation of varicella zoster virus (VZV) may be prevented with a vaccine. VZV vaccination is approved for use in the U.S. in adults at age 60.