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Zoster sine herpete with bilateral ocular involvement
M Nakamura1, M Tanabe, Y Yamada
1Department of Ophthalmology, Kobe University School of Medicine, Kobe, Japan. mxn15@psu.edu
American Journal of Ophthalmology
|August 6, 2000
Summary
Zoster sine herpete, a rare condition, can cause bilateral eye inflammation without a rash. Polymerase chain reaction on aqueous samples aids rapid diagnosis of varicella-zoster virus DNA.
Area of Science:
- Ophthalmology
- Virology
- Infectious Diseases
Background:
- Zoster sine herpete (ZSH) is a clinical presentation of varicella-zoster virus (VZV) infection characterized by dermatomal rash.
- Ocular involvement in ZSH can lead to significant visual impairment.
Observation:
- A 65-year-old male presented with bilateral iridocyclitis, sectoral iris atrophy, and elevated intraocular pressure.
- The patient had no cutaneous eruption, a key feature differentiating ZSH from typical herpes zoster ophthalmicus.
- Polymerase chain reaction (PCR) detected VZV DNA in the aqueous humor of the left eye.
Findings:
- Bilateral iridocyclitis and iris atrophy were observed.
- Intraocular pressure was elevated and unresponsive to steroid treatment.
- Systemic and topical acyclovir treatment led to prompt resolution of iridocyclitis.
Implications:
- ZSH should be considered in cases of anterior uveitis with iris atrophy, even with bilateral ocular involvement.
- PCR testing of aqueous humor is crucial for the rapid diagnosis of VZV DNA in suspected ZSH.
- Early diagnosis and antiviral treatment are essential to prevent vision loss and manage complications like secondary glaucoma.