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  • Herpes eye - Causes, symptoms and treatment. MF.

    Herpetic infection can affect all organs and systems, including the eyes. The most common diseases - shingles, skin lesions of the eyelids, conjunctivitis, keratitis, inflammation of the choroid( iridocyclitis and chorioretinitis), optic neuritis, herpetic retinopathy, acute retinal necrosis. All these diseases have in the overwhelming majority of cases a chronic course and often lead to complications.

    Causes of a herpetic eye injury

    By the time of onset, herpes is acquired and congenital. Herpes is caused by type 1, type 2 virus and Varicella Zoster. Predisposing factors:

    - hypothermia
    - stress
    - concomitant severe diseases that contribute to a decrease in immunity, including infectious
    - immunodeficiency
    - malnutrition
    - prolonged intake of antibiotics

    Herpetic infection is a highly contagious disease. Transmission ways: airborne, contact, sexual, ascending( from other organs), transplacental.

    Symptoms of herpes in the eyes

    Herpes zoster with manifestations on the eyes occurs when the first branch of the trigeminal nerve is involved in the inflammatory process. First, the pain on the affected side, the malaise, the body temperature can rise. Then on the reddened skin there are bubbles with transparent contents, then it becomes turbid, and crusts form which can leave scars.

    The skin of the upper eyelid and the region of the eyebrow, rarely the lower eyelid( when 2 nerve branches are affected) is affected. Regional lymph nodes increase and become painful. If nervus nasociliaris is involved in the process, then characteristic rashes appear at the inner corner of the eye and on the cornea. Almost always, the virus affects one half of the face.

    Symptoms of herpes on the eyes

    With herpes of the skin of the eyelids, severe itching and burning occurs, on the hyperemic( reddened) skin appear bubbles, the contents become turbid, then crusts form. When they are combed, scars remain.

    There are 3 forms of herpetic conjunctivitis: follicular, catarrhal and vesicular-ulcerative .

    The first type of has a slow flow, is characterized by blurred red eyes and a mild detached discharge. There are no typical symptoms.

    With the catarrhal form of , complaints are more pronounced, with an acute course.

    Classical manifestations of vesicular herpetic conjunctivitis - rashes in the form of vesicles, formation of crusts without scars.

    Vesicular form of viral conjunctivitis

    Keratitis , caused by the herpes virus, is divided into tree, marginal, corneal erosion, discoid, bullous, metaherpetic. Symptoms of all kinds are similar. Characterized by blepharospasm( it is impossible to open the eyes), photophobia and lacrimation, pain. The sensitivity of the cornea decreases, which can lead to accidental injuries and secondary infection. On the cornea appear rashes and infiltrates. The most pathognomonic herpetic keratitis is dendritic. In this case, the bubbles appear along the nerve fibers of the cornea. Frauding, they cause painful sensations.

    Keratitis caused by the herpes virus

    Discoid keratitis refers to the deep. There is a rounded opacity of the stroma of the cornea. Perhaps the appearance of folds descemet membrane and precipitates on the endothelium. Often passes into iridocyclitis. The forecast is unfavorable, becauseoften there are opacities of the cornea.

    Deep keratitis refers to keratouveitis .In these cases, the symptomatology of iridocyclitis joins symptoms of corneal inflammation.

    Iridocyclitis , caused by the herpes virus, can occur in acute, subacute and sluggish form. The nature of the process is serous and serous-fibrinous. Characteristic pain in acute and subacute flow, pericorneal injection of the conjunctiva, sebaceous precipitates on the endothelium of the cornea, the moisture of the anterior chamber opalesces( if secondary flora, hypopion is attached), hyphema( erythrocytes in the anterior chamber), posterior synechia( the pupil does not expand or hasirregular shape), the formation of adhesions between the iris and the lens or in the corner of the anterior chamber( respectively, increases the intraocular pressure).The iris becomes full-blooded, edematous, the figure is smoothed.

    Acute retinal necrosis is one of the types of chorioretinitis, a possible cause is the herpes virus. It occurs more often in people with immunodeficiency( eg, HIV-infected).Symptoms: loss of vision if the central area is involved in the process. First one eye is struck, and a few months later the second one. Inflammatory foci appear, first on the periphery, then they merge, and this can lead to exudative retinal detachment. Perhaps the appearance of infiltration in the vitreous. Later, strands can be formed, leading to traction detachment of the retina. More than half of people who have experienced acute necrosis of the retina are blinded.

    Other eye diseases do not have specific manifestations of herpetic infection. The presence of the virus is detected only when examined.

    diagnosis of herpes virus

    For diagnosis are needed:

    - by external examination of the face and eyelid skin may be characteristic rash,
    - visometry - vision can be dramatically reduced in the presence of corneal infiltrates, chorioretinitis and optic neuritis,
    - perimetry,
    - analgizemetria - in case of herpetic infection the sensitivity of the cornea is reduced,
    - biomicroscopy, including after staining with fluorescein,
    - transmitted light examination to determine the transparency of the eye,
    - ophthalmoscopy, as well as examination with a Goldman lens to identify foci of infection on the fundus.

    In most cases, the symptoms are not specific for herpes, so it is impossible to diagnose without laboratory confirmation. One of the diagnostic methods is the detection of antibodies to the virus in the scrapie from the conjunctiva by the method of fluorescent antibodies. In the general analysis of blood, the level of leukocytes and lymphocytes is increased( if there is an immunodeficiency, it is lowered), with an initial infection, intradermal allergic tests are performed. Investigate the status of the immune status for the proper administration of immunomodulators. In smears -prints from the cornea and conjunctiva by the PCR method, DNA of the virus can be detected.

    The most reliable method of diagnosis is virology( growing the virus on chick embryos or special nutrient media) - but it is very expensive and long lasting( up to 3 weeks), so it is used more often for scientific purposes, and not for treatment.

    Antibodies to herpes in the blood are also determined. Elevated levels of IgG indicate a previous infection. If IgM is detected, then the process is acute. They appear on the 5th-7th day of the disease, so it does not make sense to investigate antibodies before( for example, ELISA - enzyme immunoassay).

    Consultations dermatovenereologist, infectiologist, neurologist are obligatory.

    Treating herpes eyes

    Treatment is always under the supervision of an ophthalmologist. When the skin of the face and eyelids is affected, the blisters are lubricated with acyclovir ointment 3% 4 times a day for up to 2 weeks. For drying of inflammatory elements, it is possible to use dyes locally( a solution of brilliant green, iodine solution, fucocin).

    In the conjunctival sac, Oftan-IMU is instilled 4 times a day for 10 days to prevent the spread of the infection.

    With herpes zoster and severe pain, Novocaine blockades are made, and anti-herpetic preparations are taken inside within a week( Acyclovir 5 times a day for 0.2 grams, Valaciclovir 0.5 grams 2 times a day).To accelerate the healing of locally apply physiotherapy methods of treatment( UHF, UFO).When

    herpetic conjunctivitis designate the following drugs:

    - antiviral drops and ointments - Oftan-IMU 1 drop 6 times a day, Okoferon 1 drop 6 times a day, 3% acyclovir ointment 2-3 times daily
    - antiseptic drops -Miramistin, Okomistin 1 drop 6 times a day
    - anti drops - Indokollir, Naklof, Diklof 1 drop three times a day
    - antibacterial drops accession secondary bacterial flora( Floksal, Tobrex, Oftakviks 1 drop of up to 6 times per day)
    - antihistamine drops - cromoglycasodium or Opatanol 1 drop three times a day for an allergic reaction.

    Treatment is long, at least 3-4 weeks under the supervision of the ophthalmologist .

    Complications of herpes on the eyes:

    spread of infection( keratitis), allergic reactions.

    Herpetic keratitis is the most common viral infection that affects the eyes. The treatment is complex and conducted in a hospital. Approximate scheme of treatment: bury in the affected eye 6 times a day for 1 drop of Oftan-IMU, Okoferon, Okomistin, Floksal;3 times a day Indocollir and ointment Acyclovir 3%.With deep keratitis, midriatics are prescribed to prevent the onset of synechia( Tropicamide, Midratsil 2-3 times a day).If the epithelium of the cornea is not damaged, then hormonal drops and ointments( hydrocortisone ointment 1%, dexamethasone drops 0.1% 2-3 times a day) are used. Some drugs are better administered subconjunctivally or parabulbar, for example, interferon, mezaton, dexamethasone, antibiotics. Local treatment is combined with general therapy: antiviral( acyclovir 0.2 grams 5 times a day), vitamin therapy( ascorbic acid, B vitamins).Also inducers of interferon production are shown, for example, Cycloferon according to the scheme or Amizon. If necessary, the immunologist appoints immunomodulators. Physiotherapy accelerates the healing process: UHF, UFO, magnetotherapy, laser therapy, phonophoresis.

    If conservative treatment is ineffective, use laser coagulation or cryotherapy for inflammatory foci. Complications of keratitis: uveitis, allergic reactions, corneal opacities up to the thorns.

    Treatment of for herpetic uveitis( iridocyclitis and chorioretinitis) requires an intravenous infusion of acyclovir in a dosage of 5-10 mg / kg every 8 hours, possibly intravitreal administration of valaciclovir or famciclovir. In severe cases, with proliferative changes in the vitreous body and the risk of retinal detachment, surgical treatment is indicated - vitrectomy and laser coagulation of affected areas of the retina. Complications: loss of vision, retinal detachment.

    Prevention of herpes

    Herpes affected 95% of the total population. The virus lives in the human body and may not manifest itself, but under adverse conditions there are relapses of the disease. Therefore, prevention consists in strengthening immunity, timely and complex treatment of exacerbations, nutrition and healthy lifestyle, vaccination during remission.

    Doctor ophthalmologist Letyuk T.Z.