50 years female Pain and burning sensation on left side forehead, eye and nose since 6 days. Frontal head ache. What are these lesions ? Treatment ?

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Good answers dear friends . It is classical picture of HERPES ZOSTER OPHTHALMICUS. Multiple grouped vesicles on OPHTHALMIC DIVISION OF TRIGEMINAL NERVE (Upper face) is V1 dermatome including forehead, eye and tip of nose.Periorbital distribution also there. Treatment : 1) Acyclovir 800 mg 5 times daily for 5 to 7 days. 2) Tab Gabapentine 300 mg 5 pm starting day, increased gradually adding 300 mg for 5 days ( 1500 mg)and tappering to again 300 mg every day at 5 pm. 3) Acyclovir cream application 4) on cream Apply calamine lotion . 5) Cold compresses on lesions including eye.Complications of eye effects are... Stromal keratitis, Uveitis Episcleritis Finally Acute Retinal necrosis Topical Steriods Topical antibiotics Please share your views @ Dr. Harshad Gajjar . Thank you .
Thanks for tagging sir ! In the majority of pts i have come across , there had been significant involvement of eye . But in this particular pt , only mild episcleritis seems to be present with some lid edema right now. Apart from the eye lesions mentioned by u , superficial punctate keratitis , corneal dendrites, secondary glaucoma , paralytic squint , scleritis & numular keratitis r more common. Other less common lesions r progressive outer retinal necrosis , necrotizing keratitis , zoster vasculitis affecting iris , hyphema , hypopyon & pthisis bulbi. Rx of zoster eye disease needs to be continued much longer .
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Herpes zoster opthalmicus... Very well explained by respected @Dr. L.m. Patel sir Little to add We must do slit lamp examination to rule out any corneal involvement and iridocyclitis... If so use of mydiatics like atropin eye ointment, moxiflox ketorolac eye drops and ophthalmologist opinion is must @Dr. Harshad Gajjar @Dr. Neha Mehrotra sir and mam please guide
Herpes Zoster Ophthalmicus (HZO), commonly known as shingles, is a viral disease characterized by a painful skin rash in one or more dermatome distributions of the fifth cranial nerve, shared by the eye and orbit. Rx Antiviral Analgesic Antihistaminic Antacid Antibiotic Tear Drop Corticosteroids Hygiene n nutrition.
Herpes Zoster Ophthalmicus Symptomatic treatment hydration Acyclovir 800 mg TDS to QID
@Dr. P.kishore Kumar kishor- herpes zoster opthalmicus
Herpes zoster opthalmicus.
Herpes zoster opthalmicus
DX-Herpes zoster ophthalmicus Caused by the varicella zoster virus usually HZO is a secondary manifestation of reactivation of chickenpox virus meet the patient in life before Symptoms -burning sensation, fever, malaise, Severe nuralgic pain along tha course of affected nerve, formation of vesicles and ocular complications like -conjunctivitis,zostar keratitis,scleritits or may cause secoundry glaucoma RX- SYSTEMIC THERAPY- antiviral-acyclovir 800mg x5times d x10d Analgesics- combination like PCM+pethidine as pain remain severe in 1st week Steroids-dexamethasone or beclomethasone to overcome tha postherpetic nurelgia and complications like third nerve palsy nd optic neuritis LOCAL THERAPY- Onit-antibiotic + corticosteroids Prevent the use of calamine lotion as it promotes crust formation LOCAL OCULAR THERAPY- For zoster keratitis nd sclerits RX-topical steroids 4times d Topical acyclovir 3'/, x5times a day Atropine for cycloplegic effect OD Topical antibiotics to prevent secoundry Infection....
Where is the erthymatous base and grouped vesicles with characteristic crusting in deematomal fashion that should not be unconspecuous as late ss on 8th day? Any Rash on face and pain r ehough for diagnosing HZ. Why hemicranial head sce with eye and soecially nose does not attract clusture headache? But for the dubious rash... what do u lable the cause of the headache..? How such unanimity? But for me... ?
IMPENDING H Z O WHICH IS ALLWAYS ILATERAL NOT CROSSING MDLINE PT WILL DEVOPE VESICLES SHE ALSO HAS NASAL FLSHY PTERYGIUM NEEDS COMPLETS EXPOLATION STAINING OF CORNEA TO XCLUE DNDRITIC KERATITS
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