• Abbreviations
• Leaflets

• risk of infection and immunosuppression
• systemic antivirals
• Systemic steroids
• Postherpetic neuralgia
• Cornea
  

• medics.
• pain relief ...neuropathic pain...morphine and gabapentin
• Basic text here

• PHN= postherpetic neuralgia
• ARN = acute retinal necrosis
• HZO = Herpes zoster ophthalmicus = shingles around the eye

• useful leaflet explaining the condition in some detail
• another
• shorter web page link
• retinitis

• elderly and young
• HIV+ve
• if young...test for HIV
• more severe in older patients Ophthalmology

• generally this is helpful, preventing or at least reducing PHN
• occasionally not necessary in younger well patients
• always use in the elderly and others
• treat till the vesicles stop coming
• generally 7-10 days
• immunosuppressed usually need intravenous acilcoivir (or an equivalaent potent antviral)...eg all leukaemia patients; anyone very ill
• monitor renal function and reduce dose if renal function reduces
• Aciclovir/Valciclovir/Famciclovir
• Birudin is a newer one daily drug
• traditionally we are told not to start after 3 days of vesicles...but this advice is out of dte/modified: always start if new vesicles are appearing, if immunosuppressed, start even weeks later.
• Ganciclovir can be used topically

Systemic steroids may be needed. They used to be used, then we were advised they wer unnecessary, but now believe the are sometimes necessary. Use if severe skin bullae proptosis, ophthalmoplegia, optic neuritis, ARN.

• At 12 months, 37% >60y; 50% >70y
• leading cuase of chronic pain/suicide
• severe distress
• reduced with early antiviral treatment
• treat the HZV pain early...this prevents PHN.
• use opiod analgesics early to prenent pain pathways development

• late keratitis suggests persistent activity