Download PDF
Klin Monbl Augenheilkd 2010; 227(5): 370-374
DOI: 10.1055/s-0029-1245329
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Klinik des Zoster Ophthalmicus

Clinical Presentation of Zoster OphthalmicusM. Roesel1 , A. Heiligenhaus1 , E. M. Messmer2
  • 1Augenabteilung, St. Franziskus Hospital, Münster
  • 2Augenklinik, Ludwig-Maximilians-Universität München
Further Information

Publication History

Eingegangen: 20.1.2010

Angenommen: 9.3.2010

Publication Date:
20 May 2010 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund: Zoster ophthalmicus (ZO) ist eine häufige Erkrankung insbesondere von älteren und abwehrgeschwächten Patienten. Das klinische Bild kann neben den charakteristischen Hautläsionen und der postherpetischen Neuralgie (PHN) sehr unterschiedliche Augenmanifestationen aufweisen. Methode: Dieser Schwerpunktartikel beschreibt das klinische Bild des ZO, die typischen Augenkomplikationen sowie die Therapie. Ergebnisse: 50 % der ZO-Patienten weisen eine Augenbeteiligung auf. In der akuten Phase treten Lidexanthem, Konjunktivitis und epitheliale Keratitis (bis 65 %) auf, in der späten Phase die stromale Keratitis (bis 25 %), anteriore Uveitis (bis 50 %) und akute retinale Nekrose (ARN). Typische Spätkomplikationen sind Lidfehlstellungen, neurotrophe Keratopathie (bis 25 %) und Glaukom. Die Diagnose des ZO erfolgt meist aufgrund der typischen Hautveränderungen. Bei atypischem Verlauf kommen Virusnachweis, immunhistochemische und PCR-Methoden zur Anwendung. Bei allen ZO-Patienten sollte möglichst schnell mit der systemischen antiviralen Therapie begonnen werden. Wegen der für die Langzeitprognose relevanten Begleitentzündung insbesondere bei der stromalen Keratitis, Skleritis, anterioren Uveitis und ARN ist eine Kortikosteroidtherapie bedeutsam. Schlussfolgerungen: Alle Patienten mit ZO sollten systemisch antiviral behandelt werden, um Komplikationen und Visusverlust zu verhindern. Die Prognose ist bei adäquater medikamentöser und operativer Therapie meist gut. Oft steht später die PHN im Mittelpunkt. Zur Prophylaxe des ZO und der Komplikationen ist die Zostervakzinierung sinnvoll.

Abstract

Background: Zoster ophthalmicus (ZO) is a common disease, in particular in elderly and immunocompromised patients. In addition to the characteristic dermal lesions and to the postherpetic neuralgia, the clinical appearance may include very different forms of eye involvement. Methods: This article reviews the clinical features of ZO as well as the typical eye complications and therapy. Results: 50 % of ZO patients have eye involvement. The acute phase of ZO is characterised by lid exanthema, conjunctivitis and epithelial keratitis (up to 65 %). In the late phase, stromal keratitis (up to 25 %), anterior uveitis (up to 50 %), and acute retinal necrosis (ARN) may occur. Typical complications are eyelid malposition, neurotrophic keratopathy (up to 25 %) and glaucoma. The diagnosis is usually based on the characteristic dermal lesions. In atypical cases, immunohistochemistry and PCR are tools for virus detection. All ZO patients should immediately receive systemic antiviral therapy. Corticosteroid therapy is essential for the management of the concomitant immune reaction that is relevant for the long-term prognosis, especially in stromal keratitis, uveitis, skleritis and ARN. Conclusions: All patients should receive systemic antiviral treatment to avoid complications and visual impairment. With appropriate medical and surgical therapy the prognosis is usually good. Postherpetic neuralgia is often the major issue in the later course. For the prevention of ZO and its complications, a vaccination is useful.

Schlüsselwörter

Infektiologie - intraokulare Entzündungen - Kornea

Key words

cornea - infectious Diseases - intraocular Inflammation

Literatur

  • 1 Ostler H B, Thygeson P. The ocular manifestations of herpes zoster, varicella, infectious mononucleosis, and cytomegalovirus disease.  Surv Ophthalmol. 1976;  21 148-159
    Google Scholar
  • 2 Arvin A M. Varicella-zoster virus.  Clin Microbiol Rev. 1996;  9 361-381
    Google Scholar
  • 3 Arvin A. Aging, immunity, and the varicella-zoster virus.  N Engl J Med. 2005;  352 2266-2267
    Google Scholar
  • 4 Arvin A M, Koropchak C M, Wittek A E. Immunologic evidence of reinfection with varicella-zoster virus.  J Infect Dis. 1983;  148 200-205
    Google Scholar
  • 5 Weinberg J M. Herpes zoster: epidemiology, natural history, and common complications.  J Am Acad Dermatol. 2007;  57 S130-S135
    Google Scholar
  • 6 Nagasako E M, Johnson R W, Griffin D R et al. Rash severity in herpes zoster: correlates and relationship to postherpetic neuralgia.  J Am Acad Dermatol. 2002;  46 834-839
    Google Scholar
  • 7 Liesegang T J. Herpes zoster virus infection.  Curr Opin Ophthalmol. 2004;  15 531-536
    Google Scholar
  • 8 Liesegang T J. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity.  Ophthalmology. 2008;  115 S3-S12
    Google Scholar
  • 9 Ragozzino M W, Melton L J, Kurland L T et al. Population-based study of herpes zoster and its sequelae.  Medicine. 1982;  61 310-316
    Google Scholar
  • 10 Thean J H, Hall A J, Stawell R J. Uveitis in Herpes zoster ophthalmicus.  Clin Experiment Ophthalmol. 2001;  29 406-410
    Google Scholar
  • 11 Liesegang T J. Diagnosis and therapy of herpes zoster ophthalmicus.  Ophthalmology. 1991;  98 1216-1229
    Google Scholar
  • 12 Oxman M N, Levin M J, Johnson G R et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.  N Engl J Med. 2005;  352 2271-2284
    Google Scholar
  • 13 Zaal M J, Volker-Dieben H J, D’Amaro J. Prognostic value of Hutchinson’s sign in acute herpes zoster ophthalmicus.  Graefes Arch Clin Exp Ophthalmol. 2003;  241 187-191
    Google Scholar
  • 14 LEWIS G W. Zoster sine herpete.  Br Med J. 1958;  2 418-421
    Google Scholar
  • 15 Schoenlaub P, Grange F, Nasica X et al. [Oculomotor nerve paralysis with complete ptosis in herpes zoster ophthalmicus: 2 cases].  Ann Dermatol Venereol. 1997;  124 401-403
    Google Scholar
  • 16 Sanghvi C A, Leatherbarrow B, Ataullah S. Cicatricial ectropion due to herpes zoster ophthalmicus.  J Postgrad Med. 2006;  52 153-154
    Google Scholar
  • 17 Kaufman S C. Anterior segment complications of herpes zoster ophthalmicus.  Ophthalmology. 2008;  115 S24-S32
    Google Scholar
  • 18 Kline L B, Jackson B. Herpes zoster conjunctival ulceration.  Can J Ophthalmol. 1977;  12 66-67
    Google Scholar
  • 19 Cunningham E T. Diagnosing and treating herpetic anterior uveitis.  Ophthalmology. 2000;  107 2129-2130
    Google Scholar
  • 20 Liesegang T J. Corneal complications from herpes zoster ophthalmicus.  Ophthalmology. 1985;  92 316-324
    Google Scholar
  • 21 Marsh R J. Herpes zoster keratitis.  Trans Ophthalmol Soc U K. 1973;  93 181-192
    Google Scholar
  • 22 Piebenga L W, Laibson P R. Dendritic lesions in herpes zoster ophthalmicus.  Arch Ophthalmol. 1973;  90 268-270
    Google Scholar
  • 23 Reijo Jr A, Antti V, Jukka M. Endothelial cell loss in herpes zoster keratouveitis.  Br J Ophthalmol. 1983;  67 751-754
    Google Scholar
  • 24 Cobo M, Foulks G N, Liesegang T et al. Observations on the natural history of herpes zoster ophthalmicus.  Curr Eye Res. 1987;  6 195-199
    Google Scholar
  • 25 Cobo L M. Corneal complications of herpes zoster ophthalmicus. Prevention and treatment.  Cornea. 1988;  7 50-56
    Google Scholar
  • 26 Womack L W, Liesegang T J. Complications of herpes zoster ophthalmicus.  Arch Ophthalmol. 1983;  101 42-45
    Google Scholar
  • 27 Cordero-Coma M, Anzaar F, Yilmaz T et al. Herpetic retinitis.  Herpes. 2007;  14 4-10
    Google Scholar
  • 28 Saenz-Frances F, Calvo-Gonzalez C, Jimenez-Santos M et al. Herpetic optic neuritis associated with herpetic keratitis.  Eur J Ophthalmol. 2007;  17 683-684
    Google Scholar
  • 29 Wang A G, Liu J H, Hsu W M et al. Optic neuritis in herpes zoster ophthalmicus.  Jpn J Ophthalmol. 2000;  44 550-554
    Google Scholar
  • 30 Greven C M, Singh T, Stanton C A et al. Optic chiasm, optic nerve, and retinal involvement secondary to varicella-zoster virus.  Arch Ophthalmol. 2001;  119 608-610
    Google Scholar
  • 31 Gungor I U, Ariturk N, Beden U et al. Necrotizing scleritis due to varicella zoster infection: a case report.  Ocul Immunol Inflamm. 2006;  14 317-319
    Google Scholar
  • 32 Pion B, Salu P. Herpes zoster ophthalmicus complicated by complete ophthalmoplegia and signs of pilocarpine hypersensitivity. A case report and literature review.  Bull Soc Belge Ophtalmol. 2007;  303 23-26
    Google Scholar
  • 33 Vardy S J, Rose G E. Orbital disease in herpes zoster ophthalmicus.  Eye. 1994;  8 (Pt 5) 577-579
    Google Scholar
  • 34 Pfeifer B, Kempkes K, Kramer G. Herpes zoster ophthalmicus with subsequent oculomotor paralysis and homolateral media infarct.  Klin Monbl Augenheilkd. 1989;  194 184-186
    Google Scholar
  • 35 Reshef E, Greenberg S B, Jankovic J. Herpes zoster ophthalmicus followed by contralateral hemiparesis: report of two cases and review of literature.  J Neurol Neurosurg Psychiatry. 1985;  48 122-127
    Google Scholar
  • 36 Terborg C, Busse O. Granulomatous vasculitis of the CNS as a complication of herpes zoster ophthalmicus.  Fortschr Neurol Psychiatr. 1995;  63 383-387
    Google Scholar
  • 37 Amlie-Lefond C, Jubelt B. Neurologic manifestations of varicella zoster virus infections.  Curr Neurol Neurosci Rep. 2009;  9 430-434
    Google Scholar
  • 38 Echevarria J M, Casas I, Martinez-Martin P. Infections of the nervous system caused by varicella-zoster virus: a review.  Intervirology. 1997;  40 72-84
    Google Scholar
  • 39 Kleinschmidt-DeMasters B K, Gilden D H. Varicella-Zoster virus infections of the nervous system: clinical and pathologic correlates.  Arch Pathol Lab Med. 2001;  125 770-780
    Google Scholar
  • 40 Bourke R D, Pyle J. Herpes zoster ophthalmicus and the orbital apex syndrome.  Aust N Z J Ophthalmol. 1994;  22 77-80
    Google Scholar
  • 41 Yong V K, Yip C C, Yong V S. Herpes zoster ophthalmicus and the superior orbital fissure syndrome.  Singapore Med J. 2001;  42 485-486
    Google Scholar
  • 42 Badilla J, Dolman P J. Orbital myositis involving the oblique muscles associated with herpes zoster ophthalmicus.  Ophthal Plast Reconstr Surg. 2007;  23 411-413
    Google Scholar
  • 43 Kawasaki A, Borruat F X. An unusual presentation of herpes zoster ophthalmicus: orbital myositis preceding vesicular eruption.  Am J Ophthalmol. 2003;  136 574-575
    Google Scholar
  • 44 Tseng Y H. Acute orbital myositis heralding herpes zoster ophthalmicus: report of a case.  Acta Neurol Taiwan. 2008;  17 47-49
    Google Scholar
  • 45 Braverman D L, Ku A, Nagler W. Herpes zoster polyradiculopathy.  Arch Phys Med Rehabil. 1997;  78 880-882
    Google Scholar
  • 46 Sweeney C J, Gilden D H. Ramsay Hunt syndrome.  J Neurol Neurosurg Psychiatry. 2001;  71 149-154
    Google Scholar
  • 47 Jarade E F, Tabbara K F. Presumed reactivation of herpes zoster ophthalmicus following laser in situ keratomileusis.  J Refract Surg. 2002;  18 79-80
    Google Scholar
  • 48 Korber A, Franckson T, Grabbe S et al. Ambilateral reactivation of herpes zoster V 2 following cataract operation of both eyes.  J Eur Acad Dermatol Venereol. 2007;  21 712-713
    Google Scholar
  • 49 Hoang-Xuan T, Buchi E R, Herbort C P et al. Oral acyclovir for herpes zoster ophthalmicus.  Ophthalmology. 1992;  99 1062-1070
    Google Scholar
  • 50 Colin J, Prisant O, Cochener B et al. Comparison of the efficacy and safety of valaciclovir and acyclovir for the treatment of herpes zoster ophthalmicus.  Ophthalmology. 2000;  107 1507-1511
    Google Scholar
  • 51 Gross G, Schofer H, Wassilew S et al. Herpes zoster guideline of the German Dermatology Society (DDG).  J Clin Virol. 2003;  26 277-289
    Google Scholar
  • 52 Whitley R J, Weiss H, Gnann J W et al. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group.  Ann Intern Med. 1996;  125 376-383
    Google Scholar
  • 53 Wood M J, Johnson R W, McKendrick M W et al. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster.  N Engl J Med. 1994;  330 896-900
    Google Scholar
  • 54 Zaal M J, Volker-Dieben H J, D’Amaro Jr J. Visual prognosis in immunocompetent patients with herpes zoster ophthalmicus.  Acta Ophthalmol Scand. 2003;  81 216-220
    Google Scholar
  • 55 Zaal M J, Volker-Dieben H J, D’Amaro J. Risk and prognostic factors of postherpetic neuralgia and focal sensory denervation: a prospective evaluation in acute herpes zoster ophthalmicus.  Clin J Pain. 2000;  16 345-351
    Google Scholar
  • 56 Pavan-Langston D. Herpes zoster antivirals and pain management.  Ophthalmology. 2008;  115 S13-S20
    Google Scholar

Dr. Martin Roesel, FEBO

Augenabteilung, St. Franziskus Hospital

Hohenzollernring 74

48145 Münster

Phone: ++ 49/2 51/93 30 80

Fax: ++ 49/2 51/9 33 08 19

Email: m.roesel@uveitis-zentrum.de