2. DEPARTMENT OF OPHTHALMOLOGY
SINDH GOVT. QATAR HOSPITAL
DR MARIAM KASHIF
POST GRADUATE STUDENT(MCPS)
DR JAMEEL AHMED BURNEY
SUPERVISOR/HEAD OF DEPARTMENT
3. Case
A 35 year old man presented with
Fever - 4days
Burning sensation on forehead
and around left eye - 2 days
Vesicular eruptions - 1 day
Discharge (LE) - 1 day
DV (LE) - 1 day
4. History
Low grade fever 4 days back associated
with headache, tiredness and malaise.
Pain and Burning sensation on left side of
forehead and around left eye.
1 day back eruption of groups of vesicles
on left side of forehead, left upper eyelid
and nose associated with itching and pain.
Redness and mucopurulent discharge
from left eye along with decreased vision.
5. Past History
No long term illness, decreased appetite
or weight loss.
No drug history or known drug allergies.
H/O chicken pox at the age of 10yrs.
6. Family and Social History
Unmarried, lives with parents and two
siblings; all healthy.
No addictions.
Works in garment factory.
Belongs to middle class family.
7. Medical Exam
Well oriented young man, in pain and
concerned about his condition.
Vitals: Blood pressure 120/70mmhg, pulse
80/min,temp 98 degree.
CV: regular without murmur or gallop.
Chest: clear.
Abdomen: no significant finding.
8. Ocular Exam
Visual Acuity 6/6 RE 6/12 LE
External Inspection :erythamatous skin, groups
of flesh colored vesicles on left side of forehead,
left upper eyelid, along lid margin, side and tip of
the nose. (Hutchinson's Sign)
Bilateral Ocular Motility normal
Pupillary reactions normal
9. Slit Lamp Examination
RIGHT EYE LEFT EYE
Conjunctiva Normal Hyperemia
Cornea Clear Ulcer (Dendritic in
Sensation pattern
normal Fluorescine +ve)
Sensation reduced
Anterior Normal Normal
chamber
Lens Clear Clear
Fundus Normal Normal
27. Complications
Post herpetic neuralgia : pain that remains for more than
1 month after rash has healed
75% cases (esp. over 70yrs)
aggravated by minor stimuli (touch ,heat)
Cranial nerve palsies
Third (most common)
Fourth & sixth
Optic neuritis
Encephlitis Rare
Cranial arteritis
Guillain-Barre syndrome
31. Treatment of Complications
Post herpetic neuralgia
Cold compress
Local CAPSAICIN oint (QID) /
LIDOCAINE oint
Pain killers
Oral Tricyclic antidepressants
No Post herpetic neuralgia
32. Message
A common and treatable viral infection.
Patient education/Counseling.
Post herpetic neuralgia is extremely
painful condition.
Can transmit chicken pox.
Notas del editor
Corneal edema: Cornea has a ground-glass appearance. Associated with increast intraocular pressure (acute angle-closure glaucoma). Hyphema: Blood in the anterior chamber, usually precipitated by blunt trauma. Cataract: Sudden changes in blood glucose or electrolytes can alter hydration of the lens.
Patient fixes on object 15 feet away. Light held in front of one eye for 3-5 seconds, moved across to other eye for 3-5 second, then back to 1st eye. Normal response: constriction, followed by variable amounts of redilation. Eponym: Marcus Gunn pupil (named after 19th century Scottish ophthalmologist)
If greater than 2/3 of the nasal iris is in shadow, the chamber is probably shallow and the angle narrow.
Old Schiøtz tonometers: Patient supine, cornea anesthetized. Device indents cornea. Conversion made to IOC in mmHg. Electronic tonometers: Expensive and require daily calibration.
Associated with myopia Complaints of flashing lights, floaters, then visual loss
Associated with diseases that alter blood viscosity (polycythemia, sickle-cell, leukemia)
A subtype of optic neuritis. Inflammation of the optic disc (papilla). Optic neuritis can be associated with multiple sclerosis. Differential diagnosis of retrobulbar optic neuritis also includes compressive optic neuropathy (get a brain MRI).
Vascular supply to optic nerve interrupted (Giant cell arteritis, Trauma)