java barcode generator code 128 Herpes Zoster Ophthalmicus in Objective-C

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5 Herpes Zoster Ophthalmicus
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Herpes zoster frequently involves the ophthalmic division of the trigeminal nerve It presents with malaise, fever, headache, and periorbital burning and itching These symptoms may precede the eruption by a day or more The rash is initially vesicular, quickly becoming pustular and then crusting Involvement of the tip of the nose or the lid margins predicts involvement of the eye Ocular signs include conjunctivitis, keratitis, episcleritis, and anterior uveitis, often with elevated intraocular pressure Recurrent anterior segment inflammation, neurotrophic keratitis, and posterior subcapsular cataract are long-term complications Optic neuropathy, cranial nerve palsies, acute retinal necrosis, and cerebral angiitis are infrequent problems in the acute stage HIV infection is an important risk factor for herpes zoster ophthalmicus and increases the likelihood of complications High-dose oral acyclovir (800 mg five times a day), valacyclovir (1 g three times a day), or famciclovir (250 500 mg three times a day) started within 72 hours after the appearance of the rash reduces the incidence of ocular complications but not of postherpetic neuralgia Anterior uveitis requires treatment with topical corticosteroids and cycloplegics Neurotrophic keratitis is an important cause of long-term morbidity
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Opstelten W et al Managing ophthalmic herpes zoster in primary care BMJ 2005 Jul 16;331(7509):147 51 [PMID: 16020856]
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Clinical Findings
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Patients with acute glaucoma usually seek treatment immediately because of extreme pain and blurred vision, though there are subacute cases The blurred vision is associated with halos around lights Nausea and abdominal pain may occur, and acute glaucoma must be remembered in the differential diagnosis of the acute abdomen The eye is red, the cornea steamy, and the pupil moderately dilated and nonreactive to light Intraocular pressure is usually over 50 mm Hg, producing a hard eye on palpation
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Differential Diagnosis
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Acute glaucoma must be differentiated from conjunctivitis, acute uveitis, and corneal disorders (Table 7 1)
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Treatment
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Initial treatment in primary angle-closure glaucoma is control of intraocular pressure A single 500-mg intravenous dose of acetazolamide, followed by 250 mg orally four times a day, is usually sufficient Osmotic diuretics such as oral glycerol and intravenous urea or mannitol the dosage of all three being 1 2 g/kg may be necessary if there is no response to acetazolamide Laser therapy to the peripheral iris (iridoplasty) or anterior chamber paracentesis is also effective Once the intraocular pressure has started to fall, topical 4% pilocarpine, 1 drop every 15 minutes for 1 hour and then four times a day, is used to reverse the underlying angle closure The definitive treat-
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ACUTE ANGLE-CLOSURE GLAUCOMA
ESSENTIALS OF DIAGNOSIS
Older age group, particularly hyperopes, Inuits, and Asians Rapid onset of severe pain and profound visual loss with halos around lights
CMDT 2008
million individuals and being three times more prevalent in blacks At least 25% of cases are undetected Over 90% of cases are of the open-angle type, either primary openangle or normal-tension glaucoma Worldwide, about 50% of all cases of glaucoma are due to acute (see above) or chronic angle closure due to the very high prevalence of angle closure in Asians
ment is laser peripheral iridotomy or surgical peripheral iridectomy, which should also be performed prophylactically on the fellow eye Cataract extraction is a possible alternative If it is not possible to control the intraocular pressure medically, glaucoma drainage surgery as for uncontrolled open-angle glaucoma (see below) may be required
B Secondary
In secondary acute angle-closure glaucoma, systemic acetazolamide is also used, with or without osmotic agents Further treatment is determined by the cause
Clinical Findings
Because initially there are no symptoms, chronic glaucoma is often suspected at a routine eye test Diagnosis requires consistent and reproducible abnormalities in at least two of three parameters optic disk, visual field, and intraocular pressure Optic disk cupping is identified as an absolute increase or an asymmetry between the two eyes of the ratio of the diameter of the optic cup to the diameter of the whole optic disk (cup-disk ratio) (Cup-disk ratio of greater than 05 or asymmetry of cup-disk ratio of 02 or more is suggestive) Visual field abnormalities initially develop in the paracentral region, followed by constriction of the peripheral visual field Central vision remains good until late in the disease The normal range of intraocular pressure is 10 21 mm Hg In many individuals, elevated intraocular pressure is not associated with optic disk or visual field abnormalities These persons with ocular hypertension are at increased risk for glaucoma Treatment to reduce intraocular pressure is justified if there is a moderate to high risk, determined by several factors, including age, optic disk appearance, level of intraocular pressure, and corneal thickness A significant proportion of eyes with primary open-angle glaucoma have normal intraocular pressure when it is first measured, and only repeated measurements identify the abnormally high pressure In normal-tension glaucoma, intraocular pressure is always within the normal range despite repeated measurement There are many other causes of optic disk abnormalities or visual field changes that mimic glaucoma, and visual field testing may prove unreliable in some patients, particularly in the older age group Taken together, these factors mean that the diagnosis of glaucoma is not always straightforward, hampering the effectiveness of screening programs
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