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Ophthalmic zoster: mucous plaque keratitis
Abstract:
Data taken from 1221 patients attending the Zoster Clinic of Moorfields Eye Hospital over the past 15 years were used to characterise the clinical appearance and behaviour of zoster mucous plaque keratitis (MPK). The typical greyish branching plaques are usually accompanied by a limbitis, stromal keratitis, or decrease in corneal sensation and are commonly associated with cataract, raised intraocular pressure, or corneal ulceration. MPK may begin at any time within two years of onset of the rash, but when it appears after three months there are more complications. Usually MPK settles within one month if appropriate treatment with topical steroids and acetylcysteine drops is given, but surgical intervention is sometimes required to control glaucoma or neuroparalytic keratitis or to remove cataracts. The results of surgery are surprisingly good.
Insights
Zoster mucous plaque keratitis (MPK) presents as greyish plaques, often with complications if delayed. Prompt treatment with steroids and acetylcysteine typically resolves MPK within a month, though surgery may be needed for severe cases.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Herpes zoster ophthalmicus can lead to severe ocular complications.
- Zoster mucous plaque keratitis (MPK) is a specific manifestation requiring characterization.
Purpose of the Study:
- To characterize the clinical presentation and behavior of zoster mucous plaque keratitis (MPK).
- To identify factors influencing MPK complications and outcomes.
Main Methods:
- Retrospective analysis of 1221 patients with MPK from Moorfields Eye Hospital Zoster Clinic over 15 years.
- Clinical data review including presentation, associated conditions, treatment, and surgical outcomes.
Main Results:
- MPK typically presents with greyish plaques, limbitis, stromal keratitis, and decreased corneal sensation.
- Associated conditions include cataracts, elevated intraocular pressure, and corneal ulceration.
- Delayed MPK onset (after 3 months) correlates with increased complications; most cases resolve within a month with topical steroids and acetylcysteine, but surgery is sometimes necessary.
Conclusions:
- MPK requires prompt diagnosis and management to prevent complications.
- Topical steroids and acetylcysteine are effective initial treatments.
- Surgical intervention for MPK-related complications like glaucoma or cataracts yields good results.