Herpes Zoster Oftálmico. Presentación de un caso

• Main Authors: Yey Fano Machín, Yania De La Caridad Estrada Abreu
• Format: Article
• Language: English
• Published: Universidad de Ciencias Médicas de La Habana 2015-01-01
• Series: Revista Habanera de Ciencias Médicas
• Online Access: http://www.revhabanera.sld.cu/index.php/rhab/article/view/475

<p style="text-align: justify;"><span style="font-family: verdana; font-size: small;"><strong>Introducción:</strong> la infección inicial por el virus de la varicela-<em>zoster</em> produce una enfermedad exantemática aguda (varicela). Meses después se desarrolla el <em>Herpes Zoster</em> por reactivación del virus endógeno latente. El área inervada por el nervio trigémino es la segunda en cuanto a frecuencia de afectación. Cuando la enfermedad afecta la primera división de este, recibe el nombre de <em>Herpes Zoster</em> Oftálmico y tiene especial importancia debido al peligro que implica para el ojo. <strong><br /> Objetivo:</strong> evidenciar manifestaciones clínicas, complicaciones y secuelas oftalmológicas en un paciente con diagnóstico de <em>Herpes Zoster</em> oftálmico. <strong><br /> Presentación del caso:</strong> paciente masculino de 75 años con antecedentes personales de varicela en la infancia, acude a consulta por lagrimeo, fotofobia y edema palpebral en ojo derecho, acompañado de lesiones vesiculares y costras en piel de la frente y nariz. El examen oftalmológico evidencia inyección cilio-conjuntival intensa, lesiones dendríticas  en la córnea, precipitados queráticos en endotelio corneal y Signo de Hutchinson positivo. Se diagnosticó <em>Herpes Zoster</em> oftálmico complicado con uveítis anterior aguda que dejó como secuela queratitis neurotrófica y queratoconjuntivitis seca. Se indicó, previo consentimiento informado del paciente, tratamiento con Aciclovir, prednisolona, homatropina, lágrimas artificiales y vitaminoterapia. Se realizó el diagnóstico diferencial con enfermedades que afectan piel y mucosas, en especial la conjuntiva, con lesiones vesículo-ampollar, como penfigoide cicatrizal, Síndrome de Stevens-Johnson, queratitis por herpes simple, entre otros. <strong><br /> Conclusiones:</strong> el <em>Herpes Zoster</em> oftálmico es causa importante de morbilidad ocular debido a secuelas como queratitis neurotrófica y queratoconjuntivitis seca, con el consecuente daño a la superficie ocular.</span></p><p style="text-align: justify;"><span style="font-family: verdana; font-size: small;"><strong>Palabras clave:</strong><em> Herpes zoster</em> oftálmico, queratitis neurotrófica, ojo seco, superficie ocular.</span></p><hr /><p style="text-align: justify;"><span style="font-family: verdana; font-size: small;"><strong>ABSTRACT</strong></span></p><p style="text-align: justify;"><span style="font-family: verdana; font-size: small;"><strong>Introduction:</strong> the initial infection by the virus of the varicella-zoster produces an exanthematous acute illness (varicella). A few months later the herpes zoster is developed because of a reactivation of the latent endogenous virus. The area innervated by the trigeminal nerve is the second taking in consideration its frequency. When the illness affects the first branch of the nerve, receives the name ophthalmic herpes zoster and it is very important because it is very dangerous for the eye. <strong><br /> Objective:</strong> to show the clinical manifestations evidence, complications and ophthalmic sequels in a patient with an ophthalmic herpes zoster diagnosis. <strong><br /> Case Presentation:</strong> a male patient of 75 years old  with personal medical records of varicella in the childhood, he goes to outpatient service because of  lacrimation, photophobia and great palpebral edema in his right eye, accompanied by clear watery vesicles and scabs in skin of the forehead and nose. The ophthalmic exam evidences severe ciliary and conjunctival injection, dendritic keratitis, corneal endothelial plaques and positive Hutchinson's sign.  It was diagnosed as complicated herpes zoster ophthalmicus with acute uveitis that left as a sequel a neurotropic keratitis and dry eyes. It was indicated, previous information to the patient, treatment with acyclovir, prednisolone, homatropin, artificial tears and multivitamins. It was carried out the differential diagnosis with illnesses that affect skin and mucous, especially the conjunctive one, with lesions to blister as cicatrizal pemphigoid, Stevens-Johnson syndrome and herpes simplex keratitis. <strong><br /> Conclusions:</strong> the <em>herpes zoster ophthalmicus</em> is an important cause of ocular morbidity due to the sequels like the neurotropic keratitis and dry eyes, with the consequent damage to the ocular surface.  </span></p><p style="text-align: justify;"><span style="font-family: verdana; font-size: small;"><strong>Key words:</strong> <em>Herpes Zoster ophthalmicus</em>, neurotropic keratopathy, dry eyes, ocular surface.</span></p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves /> <w:TrackFormatting /> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> 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