[Clinical evaluation of impression cytology in diagnosis of superficial viral infections]

Herpes zoster ophthalmicus in otherwise healthy children

PURPOSE

To evaluate the complications of herpes zoster ophthalmicus (HZO) in children.

DESIGN

Prospective-observational case series.

METHODS

Ten healthy patients (five boys, five girls) with HZO were prospectively followed. Data regarding best-corrected visual acuity, biomicroscopy, intraocular pressure, corneal sensitivity, and funduscopy were collected. The median duration of follow-up was 19 months (range eight to 78 months).

RESULTS

The mean age at presentation was 8.7 years (range two to 14 years +/-3.95). At last visit, two patients (20%) had decreased visual acuity and nine (90%) had some degree of abnormal corneal sensitivity and corneal opacity despite good final visual acuity.

CONCLUSION

In general, HZO seems to have a good prognosis in healthy children; nonetheless, some cases can present severe eye complications causing visual loss.

Longitudinal analysis of varicella-zoster virus DNA on the ocular surface associated with herpes zoster ophthalmicus

PURPOSE

Longitudinal analysis of varicella-zoster virus DNA on the ocular surface of patients with herpes zoster ophthalmicus.

METHODS

Clinical specimens were obtained from the bulbar conjunctival surface with a cotton-tipped swab at weekly intervals for 6 consecutive weeks from 21 patients with acute ophthalmic zoster with a skin rash duration of less than 7 days. All patients received oral valacyclovir 1000 mg three times daily for 10 days without additional corticosteroids. The swabs were analyzed by means of polymerase chain reaction for the presence of varicella-zoster virus and herpes simplex virus type 1 DNA. Conjunctival swabs were also obtained from a control group of 20 patients with cataract.

RESULTS

On inclusion, varicella-zoster virus DNA was present on the ocular surface of 19 of the 21 patients. Six varicella-zoster virus DNA-positive patients had no signs of ocular inflammation. All control swabs were negative for both varicella-zoster virus and herpes simplex virus DNA. The duration of varicella-zoster virus DNA detection from rash onset varied from 2 to 34 days. The number of days between the onset of herpes zoster skin rash and the latest positive varicella-zoster virus DNA test was significantly longer in patients whose age was equal to or above the median age of 66 years than in the younger patients (Mann-Whitney test: P =.0004). At 6-week follow-up, all conjunctival swabs were negative for varicella-zoster virus DNA. However, at that time, the eyes of seven patients were still inflamed.

CONCLUSION

The duration of varicella-zoster virus DNA shedding in herpes zoster ophthalmicus is highly variable and age dependent, and is probably related to the host immune response.