Corneal epithelial keratitis in herpes zoster ophthalmicus: "delayed" and "sine herpete". A non-contact photomicrographic in vivo study in the human cornea.
OBJECTIVE
To investigate the origin of corneal epithelial keratitis occurring without accompanying herpes zoster ophthalmicus (HZO) cutaneous rash.


METHODS
Corneal epithelial lesions in seven patients (four with a history of classical HZO with cutaneous rash, one of herpes zoster oticus, and two with no history of herpes zoster, were examined with the slit lamp and photographed by non-contact in vivo photomicrography. The findings were compared with lesions in classical acute HZO. Polymerase chain reaction (PCR) was done in three patients.


RESULTS
Slit lamp appearance, morphology at higher magnification, and kinetics of the lesions were indistinguishable from classical acute HZO. PCR was positive for varicella-zoster virus DNA in all three samples.


CONCLUSIONS
The findings strongly suggest that HZO typical corneal epithelial lesions occurring in the absence of cutaneous rash are in fact recurrent episodes of virus shedding.
Tabery
H M
HM
Department of Ophthalmology, Malmö University Hospital, Sweden. helena.tabery@oftal.mas.lu.se
D000368:Aged; D000369:Aged, 80 and over; D004279:DNA, Viral / Q000032:analysis; D019573:Epithelium, Corneal / Q000473:pathology / Q000821:virology*; D005260:Female; D006563:Herpes Zoster Ophthalmicus / Q000473:pathology / Q000821:virology*; D016697:Herpes Zoster Oticus / Q000473:pathology / Q000821:virology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D016849:Keratitis, Herpetic / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012008:Recurrence; D017201:Virus Shedding / Q000502:physiology; D031368:Zoster Sine Herpete / Q000473:pathology / Q000821:virology*
D004279:DNA, Viral