09/02/2025
Ocular Disease case at our office:
Herpes Zoster Opthalmicus:
Hutchinson's sign: skin lesions, such as a vesicular rash, that appear on the tip, side, or root of the nose.
Pseudodentritic, conjunctival lessons. HSK is caused by the herpes simplex virus (HSV), while HZK is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox and shingles
Herpes Simplex Keratitis (HSK):
Causative Agent: HSV (primarily HSV-1, but HSV-2 can also be involved).
Typical Presentation: Often starts with a punctate epithelial keratitis, which can progress to a characteristic dendritic (branching) ulcer on the cornea.
Disease Course: Recurrent, with episodes triggered by various factors. Can involve the corneal epithelium, stroma, or endothelium, leading to potential scarring and vision loss.
Herpes Zoster Keratitis (HZK):
Causative Agent:
VZV, reactivated from a latent state, causing shingles (herpes zoster) which can then involve the eye as herpes zoster ophthalmicus (HZO).
Typical Presentation:
Often occurs in older adults (over 50) or immunocompromised individuals, and may present with pain, rash, and blisters on the forehead and around the eye (Hutchinson's sign).
Disease Course:
Reactivation of VZV, leading to HZO and potentially HZK (corneal inflammation). Can affect the corneal epithelium, stroma, or endothelium, with stromal inflammation being common and potentially severe.
Key Differences:
Virus:
HSK is caused by HSV, while HZK is caused by VZV.
Age of Onset:
HSK can occur at any age, while HZK is more common in older adults or immunocompromised individuals.
Disease Pattern:
HSK is recurrent, while HZK is a reactivation of a prior VZV infection (chickenpox or shingles).
Clinical Presentation:
HSK often presents with dendritic ulcers, while HZK may present with a rash or blisters on the forehead or around the eye, in addition to corneal inflammation.
Treatment:
Both HSK and HZK are typically treated with antiviral medications, but the specific drugs and dosages may differ. Early diagnosis and treatment are crucial for both conditions to prevent complications like vision loss and chronic pain.
Sources:
Tracey H Nguyen OD
Image: stock.adobe.com
