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Chapter 10 : Viral Disease of the Eye
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The eye and its adnexal structures are subject to a number of viral diseases. The initial part of this chapter discusses anatomic and physiological considerations of the eye and its principal clinical syndromes. Ocular disorders are classified according to the affected anatomic structures, for the most part, for example, keratitis, uveitis, cataract, and retinitis. The latter part of this chapter discusses the eye's major viral diseases and highlights selected risk groups. The development of and advances in antiviral therapies have made many of the viral diseases of the eye amenable to treatment. Acute retinal necrosis (ARN) is most commonly caused by varicella-zoster virus (VZV) infection but it may also be caused by herpes simplex virus (HSV), cytomegalovirus (CMV), or Epstein-Barr virus (EBV) infection. The development of ARN may be related to an impairment of cell-mediated immunity. Ocular adenoviral infection results in an acute, self-limited disease that varies considerably in severity and typically affects children and young adults. As most infections with adenovirus are self-limited and resolve without sequelae, the only indications for corticosteroid use are cicatrizing conjunctival disease or visual compromise resulting from corneal cellular infiltrates or scarring.
Diagram depicting a cross-section of the eyelids and globe. (Courtesy of Lloyd-Luke Ltd.)
Sectorial atrophy of the iris and localized cataract secondary to HSV uveitis.
ARN syndrome demonstrating peripheral necrotic retinal lesions, the view of which is impeded to some extent by vitreous inflammation. (Courtesy of S. Lightman.)
Subepithelial punctate infiltrates of established adenoviral keratitis.
Primary HSV infection affecting the face and eyes bilaterally in an atopic individual.
Herpes zoster affecting the first ophthalmic division of the trigeminal nerve. Note the periocular edema, vesicles, and crusts.
(Top) Persisting epithelial ulceration secondary to unsatisfactory herpes zoster pretreatment. (Bottom) Resolution of the ulceration with inactive corneal scarring following treatment with ocular lubricants and steroids 2 years later.
Inactive corneal scarring secondary to VZV infection.
Lipid keratopathy resulting from scarring and vascularization of the cornea as a result of VZV.
CMV retinitis with a large superior sector of necrosis and perivenous sheathing. (Courtesy of R. Markham.)
Molluscum lesion of the upper eyelid margin. Note the lack of umbilication.
Herpes zoster ophthalmicus occurring in a young African patient with HIV infection. (Courtesy of I. Mohammed.)
HIV microangiopathy showing retinal nerve fiber infarcts.
Buphthalmos associated with congenital glaucoma with obvious enlargement of both the right and left corneas.
Viral causes of conjunctivitis
Viral causes of keratitis
Viral causes of scleritis and episcleritis
Viral causes of uveitis
Viral causes of retinal disease
Viral causes of ocular adnexal disease
Stromal manifestations of HSV
Viral causes of neurologic ocular disease
Anterior-segment manifestations of HIV infection
Posterior-segment manifestations of HIV infection
Neuro-ophthalmic manifestations associated with HIV infection
Viruses associated with congenital ocular disease