EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1344259
MARCH 2021 | EYEWORLD | 93 C The neurotrophic consequences of HZO are the most ominous and potentially visually sig- nificant of the protean corneal sequelae of HZO, Dr. de Luise said. "To diagnose HZO neurotrophic keratop- athy requires vigilance and a high degree of suspicion," he said. "Once diagnosed, there must be a rapid taper and cessation of any topical steroids that might be on board and the immediate institution of strategies that promote epithelial healing." These include non-preserved artificial tear gels, autologous serum tears, and Oxervate. According to Dr. de Luise, short-term use of a bandage contact lens with topical antibiotic coverage should only be employed with caution in neurotrophic keratopathy. If there is not a rapid response, then amniotic membrane graft, bridge conjunctival flap, or lateral tarsorrhaphy should be considered. Oral antivirals Dr. Cohen suggested that everyone receive a 7- to 10-day course of high-dose oral antivirals within 3 days of rash onset. This is approved and recommended, she said. Dr. Cohen noted that if a patient had an ep- isode of zoster in the eye, it's important to wait until the eye is stable before vaccination and be examined before and 3–6 weeks after each shot. Neurotrophic changes of herpes zoster ophthalmicus (HZO) keratitis Dr. Cohen said neurotrophic changes associated with herpes zoster keratitis may be less common with better antiviral treatment of acute disease. She suggested avoiding toxic medications and using lubricating drops and ointment. Tarsor- rhaphy can be effective, though she added that this option is not necessarily popular with patients. Some find Oxervate (cenegermin-bkbj, Dompe) helpful, but this option is expensive, Dr. Cohen said. She added that a PROKERA (Bio-Tissue) amniotic membrane graft can be used when you have an ulcer from neurotrophic keratopathy. Neurotrophic keratopathy is serious because there can be melting and perforation of the cornea, as well as microbial super-infection, she said. Herpes zoster ophthalmicus: Elevated, plaque-like epithelial keratitis staining with rose bengal dye continued on page 94 Herpes zoster ophthalmicus: Neurotrophic keratitis; note the central oval-shaped epithelial defect with rolled epithelial edges Source (all): Vincent de Luise, MD