Klinik des Zoster Ophthalmicus

Zusammenfassung

Hintergrund: Zoster ophthalmicus (ZO) ist eine häufige Erkrankung insbesondere von älteren und abwehrgeschwächten Patienten. Das klinische Bild kann neben den charakteristischen Hautläsionen und der postherpetischen Neuralgie (PHN) sehr unterschiedliche Augenmanifestationen aufweisen. Methode: Dieser Schwerpunktartikel beschreibt das klinische Bild des ZO, die typischen Augenkomplikationen sowie die Therapie. Ergebnisse: 50 % der ZO-Patienten weisen eine Augenbeteiligung auf. In der akuten Phase treten Lidexanthem, Konjunktivitis und epitheliale Keratitis (bis 65 %) auf, in der späten Phase die stromale Keratitis (bis 25 %), anteriore Uveitis (bis 50 %) und akute retinale Nekrose (ARN). Typische Spätkomplikationen sind Lidfehlstellungen, neurotrophe Keratopathie (bis 25 %) und Glaukom. Die Diagnose des ZO erfolgt meist aufgrund der typischen Hautveränderungen. Bei atypischem Verlauf kommen Virusnachweis, immunhistochemische und PCR-Methoden zur Anwendung. Bei allen ZO-Patienten sollte möglichst schnell mit der systemischen antiviralen Therapie begonnen werden. Wegen der für die Langzeitprognose relevanten Begleitentzündung insbesondere bei der stromalen Keratitis, Skleritis, anterioren Uveitis und ARN ist eine Kortikosteroidtherapie bedeutsam. Schlussfolgerungen: Alle Patienten mit ZO sollten systemisch antiviral behandelt werden, um Komplikationen und Visusverlust zu verhindern. Die Prognose ist bei adäquater medikamentöser und operativer Therapie meist gut. Oft steht später die PHN im Mittelpunkt. Zur Prophylaxe des ZO und der Komplikationen ist die Zostervakzinierung sinnvoll.

Abstract

Background: Zoster ophthalmicus (ZO) is a common disease, in particular in elderly and immunocompromised patients. In addition to the characteristic dermal lesions and to the postherpetic neuralgia, the clinical appearance may include very different forms of eye involvement. Methods: This article reviews the clinical features of ZO as well as the typical eye complications and therapy. Results: 50 % of ZO patients have eye involvement. The acute phase of ZO is characterised by lid exanthema, conjunctivitis and epithelial keratitis (up to 65 %). In the late phase, stromal keratitis (up to 25 %), anterior uveitis (up to 50 %), and acute retinal necrosis (ARN) may occur. Typical complications are eyelid malposition, neurotrophic keratopathy (up to 25 %) and glaucoma. The diagnosis is usually based on the characteristic dermal lesions. In atypical cases, immunohistochemistry and PCR are tools for virus detection. All ZO patients should immediately receive systemic antiviral therapy. Corticosteroid therapy is essential for the management of the concomitant immune reaction that is relevant for the long-term prognosis, especially in stromal keratitis, uveitis, skleritis and ARN. Conclusions: All patients should receive systemic antiviral treatment to avoid complications and visual impairment. With appropriate medical and surgical therapy the prognosis is usually good. Postherpetic neuralgia is often the major issue in the later course. For the prevention of ZO and its complications, a vaccination is useful.

Schlüsselwörter

Infektiologie - intraokulare Entzündungen - Kornea

Key words

cornea - infectious Diseases - intraocular Inflammation

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