VZV Foundation - A Decade Of Leadership In The Fight Against VZV Infections

	Oral Presentation Abstracts: 10 [10] *The Gladys T. Perkin Lecture* OCULAR COMPLICATIONS OF VZV *Todd P. Margolis, F.I. Proctor Foundation and the Department of Ophthalmology, UCSF, San Francisco, California, USA VZV causes a wide spectrum of ocular disease. Primary infection with VZV, or chickenpox, may be associated with a vesicular rash of the lids and/or mild conjunctivitis. Vision threatening complications are rare. In contrast, recrudescent VZV affecting the first division of the fifth cranial nerve (HZO), commonly causes serious sight threatening ocular disease. HZO can affect all ocular and adnexal structures, causing a variety of conditions including conjunctivitis, epithelial and stromal keratitis, scleritis, anterior and posterior uveitis, cranial nerve palsies, neurotropic ulceration, mucous plaque keratopathy, lid scarring and post herpetic neuralgia. HZO sine herpete is being recognized with increased frequency as are diagnostic chronic and persistent forms of HZO, especially in immunosuppressed patients. HZO is typically a much more devastating disease than ophthalmic HSV. Furthermore, management of the ocular complications of HZO can go on for years. The early use of systemic antivirals appears to reduce the anterior segment complications of this disease. Topicals steroids are used for inflammatory complications that are signt threatening but should not be used routinely. Most mild to moderate ocular inflammation is self limited and does not require topical steroids. The biggest single problem with the use of topical steroids in HZO is reducing and/or stopping their use. They need to be tapered slowly, and many patients require topical steroids for years, increasing the incidence of glaucoma and cataract. Neurotrophic keratitis is a particularly devastating and difficult to manage complication of HZO. Lubrication, elimination of toxic topical agents and tarsorhaphy are the most effective approaches to the management of neurotrophic keratitis. Topical steroid use can worsen neurotrophic keratitis and may predispose these compromised eyes to bacterial keratitis. VZV retinitis appears to be managed best with a combination of intravenous acyclovir and intravitreal foscarnet. Management of HZO in patients with HIV can be problematic. Corresponding Author: Todd Margolis, M.D., Ph.D., Profesosr of Ophthalmology and Director, F.I. Proctor Foundation, 95 Kirkham, Box 0944, UCSF, San Francisco, CA 94143-0944, USA

[10]

The Gladys T. Perkin Lecture

OCULAR COMPLICATIONS OF VZV
*Todd P. Margolis, F.I. Proctor Foundation and the Department of Ophthalmology, UCSF, San Francisco, California, USA

VZV causes a wide spectrum of ocular disease. Primary infection with VZV, or chickenpox, may be associated with a vesicular rash of the lids and/or mild conjunctivitis. Vision threatening complications are rare. In contrast, recrudescent VZV affecting the first division of the fifth cranial nerve (HZO), commonly causes serious sight threatening ocular disease. HZO can affect all ocular and adnexal structures, causing a variety of conditions including conjunctivitis, epithelial and stromal keratitis, scleritis, anterior and posterior uveitis, cranial nerve palsies, neurotropic ulceration, mucous plaque keratopathy, lid scarring and post herpetic neuralgia. HZO sine herpete is being recognized with increased frequency as are diagnostic chronic and persistent forms of HZO, especially in immunosuppressed patients. HZO is typically a much more devastating disease than ophthalmic HSV. Furthermore, management of the ocular complications of HZO can go on for years. The early use of systemic antivirals appears to reduce the anterior segment complications of this disease. Topicals steroids are used for inflammatory complications that are signt threatening but should not be used routinely. Most mild to moderate ocular inflammation is self limited and does not require topical steroids. The biggest single problem with the use of topical steroids in HZO is reducing and/or stopping their use. They need to be tapered slowly, and many patients require topical steroids for years, increasing the incidence of glaucoma and cataract. Neurotrophic keratitis is a particularly devastating and difficult to manage complication of HZO. Lubrication, elimination of toxic topical agents and tarsorhaphy are the most effective approaches to the management of neurotrophic keratitis. Topical steroid use can worsen neurotrophic keratitis and may predispose these compromised eyes to bacterial keratitis. VZV retinitis appears to be managed best with a combination of intravenous acyclovir and intravitreal foscarnet. Management of HZO in patients with HIV can be problematic.

Corresponding Author: Todd Margolis, M.D., Ph.D., Profesosr of Ophthalmology and Director, F.I. Proctor Foundation, 95 Kirkham, Box 0944, UCSF, San Francisco, CA 94143-0944, USA