Restricted accessResearch articleFirst published online 2002
Corneal Epithelial Keratitis in Herpes Zoster Ophthalmicus: “Delayed” and “Sine Herpete”. a Non-contact Photomicrographic in Vivo Study in the Human Cornea
To investigate the origin of corneal epithelial keratitis occurring without accompanying herpes zoster ophthalmicus (HZO) cutaneous rash.
Methods
Corneal epithelial lesions in seven patients (four with a history of classical HZO with cutaneous rash, one of herpes zoster oticus, and two with no history of herpes zoster, were examined with the slit lamp and photographed by non-contact in vivo photomicrography. The findings were compared with lesions in classical acute HZO. Polymerase chain reaction (PCR) was done in three patients.
Results
Slit lamp appearance, morphology at higher magnification, and kinetics of the lesions were indistinguishable from classical acute HZO. PCR was positive for varicell-azoster virus DNA in all three samples.
Conclusions
The findings strongly suggest that HZO typical corneal epithelial lesions occurring in the absence of cutaneous rash are in fact recurrent episodes of virus shedding.
RossJ.V.M.Herpes zoster ophthalmicus sine eruptione. Arch Ophthalmol1949; 42: 808–12.
3.
StavrouP., MitchellS.M., FoxJ.D., Hope-RossM.W., MurrayP.I.Detection of varicell-azoster virus DNA in ocular samples from patients with uveitis but no cutaneous eruption. Eye1994; 8: 684–7.
4.
YamamotoS., TadaR., ShimomuraY., Pavan-LangstonD., DunkelE.C.Detecting varicell-azoster virus DNA in iridocyclitis using polymerase chain reaction: A case of zoster sine herpete. Arch Ophthalmol1995; 113: 1358–9.
5.
NakamuraM., TanabeM., YamadaY., AzumiA.Zoster sine herpete with bilateral ocular involvement. Am J Ophthalmol2000; 129: 809–10.
6.
SilversteinB.E., ChandlerD., NegerR., MargolisT.P.Disciform keratitis: A case of herpes zoster sine herpete. Am J Ophthalmol1997; 123: 254–5.
7.
PowerW.J., HoganR.N., HuS., FosterC.S.Primary varicell-azoster keratitis: Diagnosis by polymerase chain reaction. Am J Ophthalmol1997; 123: 252–4.
8.
Livir-RallatosC., EI-ShabrawiY., ZatirakisP., StameyF.R., FosterC.S.Recurrent nodular scleritis associated with varicella zoster virus. Am J Ophthalmol1998; 126: 594–7.
LiesegangJ.Corneal complications from herpes zoster ophthalmicus. Ophthalmology1985; 92: 316–24.
11.
HayashiK., UchidaY., OhshimaM.Fluorescent antibody study of herpes zoster keratitis. Am J Ophthalmol1973; 75: 795–8.
12.
WenkelH., RummeltV., FleckensteinB., NaumannG.O.H.Detection of varicella zoster virus DNA and viral antigen in human eyes after herpes zoster ophthalmicus. Ophthalmology1998; 105: 1323–30.
13.
EngstromR.E., HollandG.N.Chronic herpes zoster virus keratitis associated with the acquired immunodeficiency syndrome. Am J Ophthalmol1988; 105: 556–8.
14.
MargolisT.P., MilnerM.S., ShamaA., HodgeW., SeiffS.Herpes zoster ophthalmicus in patients with human immunodeficiency virus infection. Am J Ophthalmol1998; 125: 285–91.
15.
ChernK.C., ConradD., HollandC.N., HolsclawD.S., SchwartzL.K., MargolisT.P.Chronic varicell-azoster virus epithelial keratitis in patients with acquired immunodeficiency syndrome. Arch Ophthalmol1998; 116: 1011–7.
16.
Pavan-LangstonD., YamamotoS., DunkelE.C.Delayed herpes zoster pseudodendrites. Polymerase chain reaction detection of viral DNA and a role for antiviral therapy. Arch Ophthalmol1995; 113: 1381–5.
17.
Lee-WingM.W., HodgeW.C., Diaz-MitomaE.The prevalence of herpes family virus DNA in the conjunctiva of patients positive and negative for human immunodeficiency virus using the polymerase chain reaction. Ophthalmology1999; 106: 350–4.
18.
ZaalM.J.W., Völker-DiebenH.J., WienesenM., D'AmaroJ., KijlstraA.Longitudinal analysis of varicell-azoster virus DNA on the ocular surface associated with herpes zoster ophthalmicus. Am J Ophthalmol2001; 131: 25–9.
19.
TaberyH.M., HolmO.Photography in vivo of epithelial lesions in the human cornea. Acta Ophthalmol1987; 65: 513–4.
20.
TaberyH.M.Morphology of epithelial keratitis in herpes zoster ophthalmicus. A non-contact photomicrographic study in the human cornea. Acta Ophthalmol Scand2000; 78: 651–5.
21.
TaberyH.M.Dual appearance of fluorescein staining in vivo of diseased human corneal epithelium. A non-contact photomicrographic study. Br J Ophthalmol1992; 76: 43–4.
22.
CoboM., FoulksC.N., LiesegangT.Observations on the natural history of herpes zoster ophthalmicus. Curr Eye Res1987; 6: 195–9.
