INESSS Herpes Zoster Ophthalmicus

Question 1

Prodromes that can occur 1-7 days before rash in HZO. (5)

Answer 1

1- Nerve pain (burning, tingling)
2- Eye pain
3- General malaise
4- Headache
5- Fever

Question 2

Main signs and symptoms of HZO (2)

Answer 2

1- Unilateral rash on dermatome of ophthalmic branch. Erythematous papules, progress to pustules then crust.
2- Nerve pain

Question 3

Red flags HZO (7)

Answer 3

1- Rd conjunctival or ciliary flush
2- Painful eye
3- Photophobia
4-Decreased visual acuity
5- Diplopia or limitation in extraocular movements. (CN nerve damage)
6- Significantly impaired overall health
7- Disseminated cutaneous involvement on other dermatomes

Question 4

Ddx for HZO (5)

Answer 4

1- Atopic dermatitis
2- Contact dermatitis
3- Herpes simplex
4- Impetigo
5- Infectious periorbital cellulitis.

Question 5

Physical examination HZO (4)

Answer 5

1- Visual acuity (Snellen)
2- Extraocular movements
3- Corneal integrity (fluorescein uptake)
4- Slit lamp examination (ophthalmo/opto)

Question 6

In HZO.
1- Who gets referred within 1-3 days to ophto and
2- who has to see under 24hrs

Answer 6

1- Unilateral rash along dermatome with no warning signs.
2- With warning signs, or immunocompromised or children.

Question 7

Counseling for HZO (4)

Answer 7

1- Artificial tears/eye drops for comfort
2- RTC if warning signs appear, even if tx started.
3- Avoid contact with preggo, newborn, immunocompromised.
4- Pain can persist +++, use OTC analgesics.

Question 8

Tx for HZO in adults.

Answer 8

Valacyclovir 500 to 1000mg PO TID x 7 days.

Question 9

Common side effects of antivirals (6)

Answer 9

1- Headache
2- Dizziness
3- Nausea
4- Vomitting
5- Diarrhea
6- Abdo pain

Question 10

2 considerations for antivirals.

Answer 10

Acyclovir for pregnant
Adjust with renal function

Question 11

When do you FU with HZO pt after starting tx?

Answer 11

7-10 days