ABSTRACT
Herpes zoster ophthalmicus (HZO) is an uncommon neurocutaneous condition resulting from reactivation of the varicella zoster virus in the ophthalmic division of the trigeminal nerve. Typical presentation of HZO includes a characteristic painful vesicular dermatomal rash. However, the appearance of isolated neurologic complications in the absence of ocular findings has not been previously emphasized. We observed a 47-year-old female patient with established HZO who presented with 1 week of worsening bilateral photophobia and double vision following completion of antiviral treatment. Her motility examination revealed near-complete abduction deficit of her left eye with no other signs of neurologic deficit. Slit lamp biomicroscopy, magnetic resonance imaging, and all laboratory tests were negative. After 2 tapering cycles of oral corticosteroid treatment, her photophobia resolved, and ophthalmoplegia significantly improved. The failure of antiviral therapy in preventing our patient's neurologic sequelae highlights the importance of concurrent steroid therapy in suspected HZO patients. Furthermore, the resolution of symptoms following administration of systemic glucocorticoids supports consideration of HZO complications as immune-mediated. Finally, the unusual presentation of bilateral photophobia in the absence of ocular inflammation warrants further investigation into the pathogenesis of HZO.
ABSTRACT
BACKGROUND: This article describes the differential diagnosis of conjunctival papillomas and reviews the treatment options with a focus on the new topical interferon alpha 2 beta therapy. CASE: A 45-year-old white man presented with a red right eye of approximately 6 months' duration. The lesion was suspicious and suggestive of malignancy; therefore, the patient was referred for consultation. The lesion was diagnosed as a conjunctival papilloma. The patient was placed on topical interferon alpha 2 beta eye drops, and within 2 weeks he experienced complete lesion regression. CONCLUSION: Interferons, in particular interferon alpha-2b (IFN-alpha2beta), have recently been shown to be successful in treating conjunctival papillomas and conjunctival intraepithelial neoplasia (CIN). Previously, treatment was limited to observation for asymptomatic patients. Larger lesions in symptomatic patients were treated by surgical excision and cryotherapy. Additional treatment modalities included topical antimetabolite treatment with mitomycin-C and 5-fluorouracil. These treatments, although effective, had significant attendant postsurgical complications and toxic ocular adverse reactions. Interferons represent a new successful treatment modality.
