A male patient of 68 years age, with past medical history of varicella in the childhood, has come to O.P. complaining of photophobia, with lacrimation, severe edema of both eyes, accompanied by clear watery vesicles and scabs in skin of the forehead and nose. The ophthalmic exam showed severe conjunctivitis, keratitis. Hutchinson's sign is positive. Please give the Dx and Rx?



Herpes zoster ophthalmicus showing vesicles on tip of the nose (Hutchinson rule) .When this is present the ocular involvement is almost certain. Treatment with 3% acyclovir eye ointment 5 times daily +acyclovir 800 mg 5 times daily for about 10 days ; systemic steroids are essential often for severe affection.Antibiotic eye ointment are added for skin lesions. Analgesics are essentially indicated.

Agree but I do not agree with treatment ,as I never use steroids

Herpes zosterophthlmicus vesicular stage also tip of nose Hutchinson sign . Acyclovir skin oint acyclovir Eye oin 5 hourly acyclovir 800g 5 times daily kalmina lotion for soothing skin promethazine Tab bd , cap gabapentine bd ,good protein diet .No need of antibiotic but usually usd as a cver

l h z o as h ign is present it is sure of corneal involvemrnt may be superficial kerakeratits or microdendritic keratits or keratitis profunda conditin is unilateral no crossing midline this condition of h z o leads to long standing post herpetic keratits neuralgia and scaring reatment cyclogyl eye drops idrop 3 times a day 2 non steruidal anti nflammatory eye drops 3 antibiotic eye drops 4 acylovir eye oint 5 times a day 6 artificial tears eye drops 6 penvir 650mg od for 7days inj neurobion 1am im twice a wk for 2 wks inj monocef 1 gram iv twice a day for 5 days tab vic 500mg for 1 wk soothing agents or eye oint to be put on vesicles oral anti inflammatory drugs

Typical case of herpes zooster . Also check for facial palsy. Acyclovir 800mg 5times a day, acyclovir eye ointment. Tab. Wysolone 60 mg for 1 week followed by tapping, tab.gabapentin OD, artificial tears eye drops, if needed an antibiotic and NSAID can also be added.

Herpes Zoster ophthalmicus.showing vesicles on tip of the nose. Treatment with 3%acyclovie eye ointment 5 times.

Herpes zoster ophthalmicus Tx with oral acyclovir (800mg 5 times a day ) / valacyclovir Topical acyclovir 3% 5times a day along with topical steroid to prevent from keratitis and uveitis Topical prophylactic antibiotic Oral low potent opoids for relief of pain Amitriptyline for depression if any

Herpes zoster opthalmicus. Tab Acyclovir 400mg tds for 7days days. Eye drop Acyclovir 3 times in a day. Tab Augumentin 625 mg Tds for 7 days. Tab gabapentin 300mg Hs 0r Pregabalin 75mg Bd for 3 weaks.

Herpes zoster

D.d : Pedirous dermatitis of lid skin. Erysipelas like infection of lid skin .

Lacrimal and nasociliary branches of the 1st division of the 5th nerve frequently escape but when they are involved the ocular complications are common. Hutchinson's rule is true that if the side of the tip of the nose is involved the eye is also involved.�

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