All of the following occur in herpes zoster ophthalmicus except
C i.e. Sclerokeratitis Herpes Zoster ophthalmicus commonly causes acute epithelial keratitis , nummular (anterior stromal) keratitis (40%) disciform (deep stromal) keratitis or endothelitis (34%) and serpiginous ulceration (7%). However, sclera-keratitis (limbal vascular keratitis) is least common (1%)Q. Herpes Zoster Ophthalmicus (HZO) Corneal Disease (Keratitis) It can result in significant vision loss and manifests in 5 basic clinical forms 1. Epithelial Keratitis It may be acute (develop in >50% cases) or chronic (-8% patients). Punctate epithelial keratitis is earliest finding and presents with multiple, fine, swollen, raised intraepithelial lesions located paracentrally or at the limbus which stain intensely with rose bengal but only mildly with fluorescein. These contain live virus and may resolve into elevated dendriform epithelial lesion referred to as pseudo dendrites. (Pseudodendritic keratitis) Pseudodendrites are typically smaller than dendrites, and lack terminal end bulb formations. They are transient and usually resolve within 2 weeks after the cutaneous eruption, and steroids have little to no effect. Chronic epithelial keratitis is characterized by coarse pleomorphic epithelial mucous plaques appearing 1 weeks to 1 year (usually 3-4 months) after the skin lesions. They are a/w diffuse anterior stromal haze and debridement of plaque is not a/w any damage to underlying epithelium. 2. Nummular (Anterior Stromal) Keratitis Is earliest finding of corneal stromal involvement & present during, 2^d week of disease in 25-40% of patients. - It is characterized by multiple, fine, granular, (usually) transitory infiltrates in anterior stroma in areas previously affected by either punctuate or pseudodendrites. 3. Dissiform (Deep stromal) Keratitis or Endothelitis Develop 3-4 months after initial acute phase & is usually preceeded by acute epithelial or anterior stromal keratitis. Central, well defined, disc shaped area of diffuse deep stromal edema without vascularization, corneal edema & anterior chamber inflammation may be prominent features 4. Limbal Vascular Keratitis (Sclero-Keratitis) 5. Neurotrophic Keratitis
Anterior stromal keratitis
Pseudodendritic keratitis
Sclerokeratitis
Endothelitis