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Вуз:

Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001

.pdf

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28.03.2026

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Herpes zoster ophthalmicus

•Iritis in 40% of cases

•Within 3 weeks of onset of rash

Small-medium KP

Particularly if external nasal branch involved - Hutchinson sign

Iris atrophy - 20%

Acute retinal necrosis

•Affects healthy individuals (bilateral in 30-50 %)

•Herpes simplex in young patients

•Herpes zoster in older patients


•	Peripheral vasculitis	• Vitritis and anterior uveitis
•	Peripheral vasculitis
•	Deep, multifocal, yellow,
	necrotic infiltrates


• Confluence but sparing of		• Residual RPE atrophy
	posterior pole until late	after 4-12 weeks

Acute retinal necrosis

Treatment options

•Systemic aciclovir, steroids, aspirin

•Laser photocoagulation to limit progression

Complications

•Retinal detachment

•Ischaemic optic neuropathy

Acquired immune deficiency syndrome (AIDS)

Opportunistic infections

Candidiasis

• Pneumocystis carinii	•	Toxoplasmosis
pneumonia	•	Atypical mycobacterium
	•	Atypical mycobacterium
	•	Cytomegalovirus
	•	Cryptococcus

Neoplasms


• Kaposi sarcoma	• Lymphoma

Anterior features


Multiple molluscum	Eyelid Kaposi sarcoma	Conjunctival Kaposi sarcoma
contagiosum


Severe herpes zoster	Peripheral herpes simplex	Microsporidial keratitis
ophthalmicus	keratitis	Microsporidial keratitis
ophthalmicus	keratitis

HIV retinal microangiopathy

• In 66% of AIDS

• In 40% of AIDS-related complex

• In 1% of asymptomatic HIV infection

• Transient cotton-wool spots

• Occasionally haemorrhages

Indolent CMV retinitis


•	Frequently starts in periphery	•	Slow progression
•	Granular opacification	•	No vasculitis
•	Granular opacification
		•	Mild vitritis

Fulminating CMV retinitis


•	Dense, white, confluent opacification	•	May be associated with venous
			sheathing
•	Frequently along vascular arcades		Mild vitritis
		•	Mild vitritis
•	Associated haemorrhages

Progression of CMV retinitis

‘Brushfire-like’ extension along course of retinal blood vessels

Optic nerve head involvement

Extensive retinal atrophy

Atrophy and retinal detachment

Treatment of CMV retinitis

Ganciclovir		Foscarnet i.v.
•	Systemic - initially i.v. then oral	Foscarnet i.v.
•	Systemic - initially i.v. then oral
•	Intravitreal - injections or	Cidofovir i.v.
	slow-release devices

Signs of regression

• Fewer haemorrhages

• Less opacification

• Diffuse atrophic and pigmentary changes

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